Anti-abortion activists march through downtown Columbus during the first Ohio March for Life on October 5, 2022.
CNN  — 

After a string of recent ballot-box victories for abortion rights groups, opponents of the procedure are redoubling their efforts – including, in some places, pushing to make it harder to use citizen-approved ballot measures to guarantee abortion access.

An anti-abortion coalition in Ohio, for instance, recently unleashed a $5 million ad buy targeting an effort to enshrine abortion rights in the state’s constitution through a ballot initiative – just as the initiative’s organizers won approval to collect signatures to put the question to voters in November. Meanwhile, legislators in Ohio and other states are weighing bills that would make it more difficult to pass citizen-initiated changes to state constitutions.

The US Supreme Court’s decision to overturn Roe v. Wade last year left abortion laws up to the states, and abortion rights groups quickly scored wins on ballot measures in six of them – including in the battleground state of Michigan, where voters protected abortion access, and in the Republican strongholds of Kansas, Kentucky and Montana, where voters defeated efforts to restrict abortions.

“What we saw in the midterms last year was a wake-up call,” said Kelsey Pritchard, director of state public affairs for Susan B. Anthony Pro-Life America. She said helping local groups defeat abortion-related ballot measures is one of the top three priorities for the group’s state affairs team.

Groups on both sides of the abortion divide have poured big sums into an upcoming state Supreme Court race in Wisconsin that has seen record spending and offers a key test of the potency of the abortion issue among voters in a battleground state. Whether a conservative or liberal candidate wins a swing seat Tuesday on the seven-member high court there could determine the fate of abortion rights in the state. A Wisconsin law, enacted in 1849, that bans nearly all abortions is being challenged in court and is likely to land before the state Supreme Court.

More fights over ballot initiatives on abortion are stirring to life around the country. In addition to Ohio – where a state law banning abortion as early as six weeks into a pregnancy has been put on hold by a judge – abortion rights proponents have begun to push ballot proposals in South Dakota and Missouri. Most abortions are now illegal in those two states.

And groups in at least more six states are considering citizen initiatives as a way to guarantee or expand access to abortions, said Marsha Donat, capacity building director at The Ballot Initiative Strategy Center, which helps progressive groups advance ballot measures.

Battleground Ohio

Ohio, however, looms as the next big abortion battleground on the 2023 calendar – with skirmishes already underway in the courts, the state legislature and on the airwaves.

A state “fetal heartbeat” law that prohibits many abortions as early as six weeks into pregnancy took effect when the US Supreme Court struck down Roe with its decision last June in Dobbs v. Jackson Women’s Health Organization. But the law has been put on hold by a judge in Cincinnati in a case that’s expected to end up before the state’s high court.

Abortion rights supporters recently won approval to begin collecting signatures to put a measure on the November ballot that would guarantee Ohioans’ access to abortion. If approved by voters, state officials could not prohibit abortion until after fetal viability, the point at which doctors say the fetus can survive outside the womb.

The initiative says that “every individual has a right to make and carry out one’s own reproductive decisions, including but not limited to decisions” on contraception, fertility treatment, continuing one’s own pregnancy, miscarriage care and abortion.

It also would bar the state from interfering with an individual’s “voluntary exercise of this right” or that of a “person or entity that assists an individual exercising this right.”

A conservative group called Protect Women Ohio immediately launched an ad campaign – putting $4 million on the air and $1 million into digital advertising – to cast the amendment as one that would strip parents of their authority to prevent a child from having an abortion or undergoing gender reassignment surgery, although the proposed constitutional amendment makes no mention of transgender care.

Officials with Protect Women Ohio argue that the initiative’s language is broad enough to be interpreted as extending to gender reassignment surgery, an assertion initiative proponents say is false.

In the campaign aimed at defeating the amendment, “we’ll make sure they have to own every last word of this radical initiative,” said Aaron Baer, the president of Center for Christian Virtue and a Protect Women Ohio board member, told CNN. “They chose this language for a reason, and we’re not going to let them off the hook.”

Lauren Blauvelt – who chairs Ohioans for Reproductive Freedom, the group promoting the initiative – said the ad “is completely wrong” and called it an “unfortunate talking point from the other side.”

“Our amendment … creates the fundamental right that an individual can make their own reproductive health care decisions” and does not touch on other topics, she said.

But the ad campaign highlights the effort to link abortion to the transgender and parental rights issues currently animating conservative activists.

Susan B. Anthony’s Pritchard said she believes that her side can win on the issue of limiting abortions but “we believe also that we broaden our coalition and broaden awareness of what these things actually do when we highlight the parental rights issue that is very real.”

The initiative’s supporters need to collect more than 413,000 signatures from Ohioans by July 5 to qualify for the November ballot. Under current Ohio law, changes to the state’s constitution can be approved via ballot initiative by a simple majority of voters.

A bill introduced by Republican state Rep. Brian Stewart would increase that threshold to 60% and would mandate that the signatures needed to put an amendment on the ballot come from all 88 counties in the state, instead of 44, as currently required.

Ohio state Senate President Matt Huffman backs raising the threshold and also supports holding an August special election to change the ballot initiative rules. If successful, the higher threshold would be in effect before November’s election when voters could consider adding abortion rights to the state constitution.

Neither Huffman nor Stewart responded to interview requests from CNN.

Ohio lawmakers recently voted to end August special elections, citing their expense and low participation. But Huffman recently told reporters in Ohio that a special election – with a potential price tag of $20 million – would be worth the expense if it helped torpedo the abortion initiative.

“If we save 30,000 lives as a result of spending $20 million, I think that’s a great thing,” he said, according to Cleveland.com.

Changes to initiative rules

The Ballot Initiative Strategy Center is tracking 109 measures across 35 states that could affect initiatives put to voters in 2024. Some would increase the threshold for an initiative to pass. Others would increase the minimum number of signatures – or require that they come from a broader geographic area – before an initiative could qualify for the ballot in the first place, Donat said.

Many of the bills that seek to make it more difficult to pass ballot initiatives do not specifically target abortion issues. But they come as progressive groups increasingly turn to the initiative process as a way to bypass Republican-controlled legislatures and put a raft of issues – from legalizing marijuana to expanding Medicaid eligibility and boosting the minimum wage – directly to voters.

“Attacks, through state legislatures, on the ballot measure process have been pretty consistent and pretty aggressive for the last several (election) cycles,” said Kelly Hall, executive director of the Fairness Project, which has helped pass progressive measures in red states.

Hall said the abortion issue, while not the sole focus of current efforts to curb ballot initiatives, has put “additional fuel on an already burning fire.”

In Missouri, a state law banning most abortions – including in cases of rape and incest – took effect last year after Roe was overturned. A group called Missourians for Constitutional Freedom has filed petition language that proposes adding abortion protections to the state constitution via ballot initiative. In recent cycles, voters in Missouri have expanded Medicaid eligibility and legalized recreational marijuana use through such initiatives.

This year, the state’s Republican-controlled legislature is weighing making it harder for those initiatives to succeed. In February, the state House voted to raise the bar for amending the state constitution from a simple majority to 60%. Voters would have to approve the higher threshold.

“I believe the Missouri Constitution is a living document but not an ever-expanding document,” Republican state Rep. Mike Henderson, the measure’s sponsor, said during House floor debate. “And right now, it has become an ever-expanding document.”