On Nov. 5, 2024, voters in 10 states decided on 11 abortion-related ballot measures—the most on record for a single year, surpassing the record set by 2022, when six abortion measures were decided by voters.
In 2024, 10 measures were to establish new constitutional rights to abortion or reproductive healthcare decisions. Voters in seven states—Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York—approved the constitutional amendments. Adoption of Amendment 3 in Missouri marked the first time voters approved a right-to-abortion amendment that overturned a six-week abortion ban.
Three amendments were defeated in Florida, Nebraska, and South Dakota. This is the first time right-to-abortion ballot measures have failed since the Dobbs v. Jackson Women’s Health Organization U.S. Supreme Court decision, which overturned Roe v. Wade.
Florida Amendment 4 received 57% of the vote. However, in Florida, constitutional amendments must receive 60% of the vote. Florida Amendment 4 was the most expensive abortion measure—and the second-most expensive measure on the ballot in the U.S. in 2024—with $119 million spent by the support campaign and $12 million spent by the opposition campaign.
In Nebraska, there were two competing initiatives on the ballot—Initiative 434 and Initiative 439. Initiative 434, which amended the constitution to prohibit abortion after the first trimester, was approved, while Initiative 439, which would have established the right to abortion before fetal viability, was rejected by voters. If both of the measures had passed, because they were in competition with one another, the measure with the greater number of votes would have been adopted.
Nebraska Initiative 434 was the first measure to be placed on the ballot Post-Dobbs proposing to establish constitutional limits or restrictions on abortion. Initiative 434 amended the state constitution to prohibit abortion after the first trimester unless necessitated by a medical emergency or if the pregnancy is a result of sexual assault or incest.
The following eight measures were approved:
- Arizona Proposition 139: Amended the constitution to establish that every individual has the fundamental right to abortion that the state of Arizona may not interfere with before the point of fetal viability.
- Colorado Amendment 79: Established a right to an abortion in the state constitution and repealed the restriction on the use of public funds for abortions.
- Maryland Question 1: Added a new article to the Maryland Constitution’s Declaration of Rights establishing a right to reproductive freedom, defined to include “the ability to make and effectuate decisions to prevent, continue, or end one’s own pregnancy.”
- Missouri Amendment 3: Added a fundamental right to reproductive freedom, defined to include abortion and “all matters relating to reproductive health care,” to the Missouri Constitution, among other provisions.
- Montana CI-128: Provided a state constitutional “right to make and carry out decisions about one’s own pregnancy, including the right to abortion,” and allowed the state to regulate abortion after fetal viability, except when “medically indicated to protect the life or health of the pregnant patient.”
- Nebraska Initiative 434: Amended the state constitution to prohibit abortions after the first trimester unless necessitated by a medical emergency or the pregnancy is a result of sexual assault or incest.
- Nevada Question 6: Provided for a state constitutional right to an abortion, and for the state to regulate abortion after fetal viability, except where medically indicated to “protect the life or health of the pregnant patient.” In Nevada, initiated constitutional amendments need to be approved in two even-numbered election years, meaning that Question 6 needs to be approved in 2024 and 2026 to amend the Nevada Constitution.
- New York Proposal 1: Added language to the New York Bill of Rights to provide that people cannot be denied rights based on their “ethnicity, national origin, age, and disability” or “sex, including sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes, and reproductive healthcare and autonomy.”
The following three measures were defeated:
- Florida Amendment 4: Would have added the following language to the Florida Constitution’s Declaration of Rights: “… no law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider.”
- Nebraska Initiative 439: Would have amended the state constitution to establish a right to abortion until fetal viability.
- South Dakota Constitutional Amendment G: Would have provided a state constitutional right to abortion and stated that the state could not regulate abortion before the end of the first trimester. During the second trimester, the state would have been allowed to regulate abortion, but only in ways reasonably related to the physical health of the pregnant woman. In the third trimester, the state could have regulated or prohibited abortion, except when abortion was necessary, in the medical judgment of the woman’s physician, to preserve the life and health of the pregnant woman.
Between 2022 and 2023, there were seven abortion-related measures that appeared on the ballot—six in 2022 and one in 2023. Four of these measures had campaigns that described themselves as pro-choice—one of these measures occurred in a state with Democratic partisan control of the state legislature, one occurred in a state with Republican partisan control, and two occurred in states with divided control. All four of these measures were approved by voters. Three of the abortion-related measures on the ballot had campaigns that described themselves as pro-life. One occurred in a state with Republican partisan control, while two others occurred in a state with divided partisan control. All three of these measures were rejected by voters.
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