In the November 2026 election, voters in three states (Idaho, Nevada and Virginia) will consider ballot measures designed to protect abortion rights by affirming a statutory or constitutional right to abortion and in some cases other reproductive rights. Additionally, voters in one state (Missouri) will vote on an anti-abortion measure that would undo the right to reproductive freedom previously established by a state ballot measure.
Idaho is the only state featuring a protective abortion rights ballot measure that is also enforcing a total ban on abortion—which would likely be challenged in court should the ballot measure pass. Data from Guttmacher's Monthly Abortion Provision Study show that in 2025, 850 abortions were provided via telehealth to Idaho residents by clinicians based in other US states and under the protection of shield laws, due to the total ban in effect. In the other states featuring abortion rights ballot measures this year, over 59,000 abortions were provided by clinicians in 2025—the vast majority of which were provided in Virginia.
While measures that add constitutional or statutory protections for abortion are vital, they do not automatically repeal restrictions, and litigation is often needed to overturn them. Moreover, protections for abortion rights may fall short of ensuring access to care for everyone who needs it. Such laws often protect abortion access up to “viability” (a medically variable threshold that is often reached between 24–26 weeks of pregnancy) and often allow the state to regulate abortion care after viability.
Efforts to restrict abortion often intersect with other movements aimed at restricting people’s rights. Voters in a total of five states will face ballot measures this fall that would undermine the rights of transgender minors, primarily by targeting best practice gender-affirming care for young people and sports participation by trans youth. The anti-abortion measure in Missouri also targets gender-affirming care for minors, which is already banned in the state.
Given the success of ballot measures protecting abortion access in states across the country, anti-abortion advocates have become increasingly forceful with strategies aimed at restricting ballot measures at every stage of the process. In several additional states this year, voters will face propositions that will make it more difficult to pass ballot measures. A similar effort already failed in Missouri in August 2026—when voters declined to pass a measure that would have dramatically restricted future ballot initiatives by requiring them to be approved by a majority of voters in every congressional district, rather than a state-wide majority.
Ballot Measures Have Protected and Expanded Abortion Access
Ballot measures affirming abortion rights have been effective tools for expanding and protecting abortion rights, even in states with abortion restrictions. In the 2024 elections, 10 states featured ballot measures affirming abortion rights, and seven of these passed. In elections in 2022 and 2023, voters in all seven states where abortion rights measures were on the ballot came down decisively in favor of retaining or expanding such rights.
Since the 2024 ballot measure victories, advocates in states with abortion restrictions have used these new protections as a legal basis to expand abortion access. In 2024, Missouri voters established a right to reproductive freedom in their state constitution, providing a legal avenue to overturn the state's total abortion ban. Litigation and ensuing court rulings repealed Missouri’s abortion restrictions, eventually allowing procedural abortion care to resume in the state in 2025 and for medication abortion provision to return in June 2026 for the first time since 2018. Similarly, in Arizona, voters protected the right to abortion through a ballot measure in November 2024, providing a legal avenue to strike down the state's 15-week ban later that year. Ensuing litigation also lifted additional restrictions in February 2026, rescinding bans on telehealth and the mailing of abortion pills, while removing mandates for biased counseling, medically unnecessary ultrasounds, and punitive waiting periods that made it more difficult for people to access abortion care in Arizona.
The anti-abortion measure Missouri voters will face this fall threatens to undo the progress that has allowed hundreds of Missourians to access care in their state earlier this year.
