Eleven abortion referendums will be in front of voters in 10 states this Election Day the largest number of pro-choice amendments the country has ever seen during a single election cycle.

From red states like Missouri and South Dakota to blue states like New York, the abortion rights ballot measures could have a monumental impact on access throughout the country. Over 20 states have enacted abortion bans since the Supreme Court repealed federal abortion protections in 2022. Citizen-led initiatives, like most of this years abortion rights measures, have become the response to many of the near-total abortion bans passed by Republican-controlled state legislatures.

This is a public health crisis that we have right now, said Chris Melody Fields Figueredo, executive director at the Ballot Initiative Strategy Center, who has worked with campaigns in all 10 states where an abortion rights amendment is in play. The citizens, in the absence of their local elected officials, are addressing it. Theyre taking power into their own hands.

In 2022, there were six ballot measures addressing abortion, which at the time was the most in a single year. Voters protected abortion care in every state it was on the ballot during that election cycle, including in deeply Republican states like Kentucky . Ohio, a state with a long and extreme anti-abortion history, also voted to codify abortion rights into its state constitution just last year.

This years ballot measures range in their approaches to and levels of abortion protections. Nebraska will have two competing abortion measures, one to restrict access and one to expand. Maryland, New York and Colorado are all seeking to codify abortion protections throughout pregnancy exceptions to the rest of the measures, which would primarily enshrine access until viability or around 24 weeks. Colorados Amendment 79 would also allow the use of public funds for abortion care. Missouris Amendment 3 would restore abortion access until viability and protect women from being prosecuted for pregnancy outcomes like miscarriage and stillbirth a particularly progressive measure in a notoriously anti-abortion state.

If passed, most amendments would generally go into effect shortly after Election Day or at the start of 2025. Measures in Montana and South Dakota would tentatively go into effect in July 2025, while Nevadas may not until 2026. There will be litigation in any state that passes a pro-choice measure; this is likely the time when states will bring legal challenges against successful ballot initiatives and fight to keep other abortion regulations like waiting periods and other long-standing targeted restrictions on abortion providers.

The historic number of abortion rights measures is emblematic of just how politically prominent abortion care has become. And despite conservatives who claim to want to leave abortion to the states since Roe fell, many did everything in their power to stop voters from weighing in on abortion rights measures.

This is not just a reproductive freedom issue, its also a democracy issue, Fields Figueredo said. Its about who has power and who has the determination to control what happens to their body.