In the November 2024 election, a record-breaking 10 US states featured ballot measures that would enshrine abortion rights, and in some cases other reproductive rights, in the state constitution, and one state also featured an anti-abortion measure. Two of these states—Missouri and South Dakota—have total abortion bans in place. In the remaining eight states, data from Guttmacher’s Monthly Abortion Provision Study show that an estimated 308,210 abortions (or about 30% of the national total) were provided by clinicians in these states in 2023. Seven out of the 10 ballot measures supporting abortion rights passed and the anti-abortion measure in Nebraska also passed. 

State Ballot Measures Can Offer Protection for Abortion Rights

In the 18 states where a citizen-led ballot initiative process is available, ballot measure campaigns give state advocates a high-profile opportunity to highlight abortion rights and allow voters to have a direct say in the future of abortion access in their state. Abortion-related state ballot initiatives are not new, but proposing these measures has become one of several major strategies to protect abortion rights at the state level after the US Supreme Court overturned Roe v. Wade. Between June 2022 and November 2023, voters in all seven states where measures on abortion have been on the ballot (California, Kansas, Kentucky, Michigan, Montana and Vermont in 2022; Ohio in 2023) have come down decisively in favor of retaining or expanding abortion rights by either enshrining a right to abortion in the state constitution or defeating a proposed anti-abortion measure. 

These ballot measure wins have had concrete results in states with restrictive policies. However, adding constitutional protection does not automatically repeal bans or restrictions; litigation is often necessary to overturn pre-existing state laws. For example, in Ohio, where voters enshrined the right to abortion in the state constitution via a ballot measure in November 2023, subsequent litigation allowed the state’s six-week abortion ban to be permanently blocked and several notable abortion restrictions to be temporarily blocked in late 2024. In Kansas, voters rejected an anti-abortion ballot measure in 2022 that would have amended the state constitution to explicitly exclude abortion rights; in 2024, the state supreme court struck down several abortion restrictions and reaffirmed protection for abortion in the state constitution.

State constitutional protections also may fall short of securing abortion access for all people who need it. For example, such amendments often do not include protections for abortion later in pregnancy and may leave in place restrictions on access for young people. Moreover, in many states, there were strong challenges to placing a supportive measure on the ballot from policymakers and groups seeking to restrict abortion. In some states, like Arkansas, opponents were successful in blocking a measure on abortion rights from appearing on the ballot this year. In states considered hostile to abortion where a ballot measure protecting abortion rights has now passed, similar actors likely will be working to undermine its impact, and they may be further emboldened by the hostile incoming presidential administration. 

Meanwhile, in states that have been protective of abortion rights and expanding access (e.g., California, Colorado, Maryland, New York), adding constitutional protections provides an additional firewall against potential efforts by future anti-abortion policymakers to restrict those rights. 

Access to abortion continues to mobilize voters across the country, in the seven states with successful ballot initiatives and even those where a measure did not pass this year. In Florida, the abortion rights measure garnered more than 57% support, but it did not clear the state’s high threshold (60%) for passing a constitutional amendment. Now more than ever, policymakers at all levels of government must work to protect and expand abortion rights and access.

2024 State Ballot Measures on Abortion

Arizona

PASSED: Proposition 139 (Right to Abortion Initiative)

Led by Arizona for Abortion Access, this ballot measure provides a legal avenue to challenge the state’s 15-week ban by establishing a fundamental right to abortion and prevents the state from restricting abortion prior to viability in most instances (generally 24–26 weeks of pregnancy). It protects access to care after that point if necessary to protect the pregnant person’s life or health (physical or mental). The measure also prohibits any law penalizing a person or entity assisting someone to get an abortion. 

Abortion context: 

• Arizona’s policies are categorized as “Very Restrictive,” including a 15-week abortion ban. In April 2024, the Arizona Supreme Court upheld an 1864 total ban on abortion. The ban was eventually repealed and never went into effect, although it unleashed chaos and confusion on patients and providers.
• An estimated 13,900 abortions were provided by clinicians in Arizona in 2023, close to a 5% increase since 2020. 
• In 2023, Arizona residents also traveled to obtain abortion care in California (1,660), Nevada (1,080) and New Mexico (260), among other states.

Colorado

PASSED: Amendment 79 (Right to Abortion and Health Insurance Coverage Initiative)

Led by Coloradans for Protecting Reproductive Freedom, this ballot measure ensures the constitutional right to abortion and repeals a previous constitutional amendment prohibiting the use of state funds to cover abortion care. 

Abortion context: 

• Colorado's policies are categorized as “Protective.” 
• In 2023, an estimated 26,300 abortions were provided by clinicians in Colorado, a 96% increase from 2020. 
• This rise includes a significant increase in the number of out-of-state patients; the share of abortions provided to patients from other states increased from 13% to 29% from 2020 to 2023. Many of these patients came from nearby states with restrictive abortion laws, such as Texas (4,680), Oklahoma (400) and Nebraska (200). 

Florida 

DID NOT PASS: Amendment 4 (Amendment to Limit Government Interference with Abortion)

Led by Floridians Protecting Freedom, this ballot measure provides a legal avenue to challenge the state’s six-week abortion ban by ensuring that no law can prohibit, penalize, delay or restrict abortion before viability (generally 24–26 weeks of pregnancy) and when necessary after that point to protect the pregnant person’s health.  

Abortion context: 

• Florida’s policies are categorized as “Most Restrictive,” with a six-week abortion ban and other restrictions like a parental consent requirement for a minor to obtain an abortion. 
• Florida’s six-week abortion ban went into effect on May 1, and Guttmacher data show that clinician-provided abortions decreased by 31% in May and 36% in June compared with the monthly average for the first three months of the year.
• For most of 2023, a 15-week ban was in effect. There were an estimated 85,600 clinician-provided abortions in Florida in 2023, almost an 11% increase since 2020. 
• Patients across the South and Southeast traveled to Florida to seek an abortion in 2023. In that year, 11% of abortions in Florida were obtained by out-of-state residents, an estimated 9,400 patients. 
• Some Floridians were also forced to travel across the country to seek care in 2023, traveling as far as New York (660), the District of Columbia (530), California (210) and Illinois (210). 

Maryland 

PASSED: Question 1 (Right to Reproductive Freedom Amendment)

Led by Reproductive Justice Maryland, this ballot measure establishes a right to reproductive freedom in the state constitution, defined as “the ability to make and effectuate decisions to prevent, continue or end one’s own pregnancy.”

Abortion context:

• Maryland’s policies are considered “Very Protective.”
• In 2023, there were an estimated 39,000 clinician-provided abortions in Maryland, reflecting an almost 27% increase from 2020. Recently enacted state policies may have expanded access for state residents, such as funding an abortion care training program for providers and allowing qualified health professionals other than physicians to provide abortion care.
• The share of abortion patients in Maryland coming from other states has remained relatively stable from 2020 to 2023.

Missouri 

PASSED: Amendment 3 (Right to Reproductive Freedom Initiative)

Led by Missourians for Constitutional Freedom, this ballot measure provides a legal avenue to challenge the state’s total abortion ban by establishing a right to reproductive freedom in the constitution, including making decisions about abortion, contraception, miscarriage management, prenatal and postpartum care, and respectful birthing conditions without government interference. It also protects a right to assist someone exercising their reproductive freedom. The measure allows abortion to be restricted or banned after viability (generally 24–26 weeks of pregnancy), with a right to abortion after that point to protect the pregnant person’s life or health (physical or mental). 

Abortion context: 

• Missouri’s policies are categorized as "Most Restrictive," with the state enforcing a total abortion ban. 
• In 2023, the total ban forced Missouri residents to seek abortion care out of state. A significant number traveled to Illinois (8,750) and Kansas (2,850).

Montana 

PASSED: CI-128 (Right to Abortion Initiative)

Led by Montanans Securing Reproductive Rights, this ballot measure ensures a right to make and carry out pregnancy decisions, including abortion. It prevents the state from hindering the right to abortion before viability (generally 24–26 weeks of pregnancy) and when necessary after that point to protect the pregnant person’s life or physical health. It also protects patients, health care providers or anyone who assists someone in exercising their right to make decisions about their pregnancy. 

Abortion context: 

• Montana’s policies are considered “Protective.”
• Montana courts have recognized that the state’s constitutional right to privacy protects access to abortion before viability (generally 24–26 weeks of pregnancy) and have struck down multiple abortion restrictions, but this measure would go a step further by adding constitutional protection specifically for abortion.
• There were an estimated 2,200 clinician-provided abortions in Montana in 2023, a 36% increase since 2020. The increase may reflect that services like telemedicine provision of medication abortion have been able to meet a growing need for care in the state.
• The share of abortions obtained in Montana by out-of-state residents remained stable from 2020 to 2023. 

Nebraska

The state had both a protective abortion rights measure and an anti-abortion measure on the ballot. The anti-abortion measure passed.

PASSED: Initiative 434 (Prohibit Abortions After the First Trimester Amendment)

Led by Protect Women and Children, the anti-abortion ballot measure prohibits most abortions after the first trimester, enshrining the current 12-week ban in the constitution.

DID NOT PASS: Initiative 439 (Protect the Right to Abortion Amendment)

Led by Protect Our Rights, this ballot measure provides a legal avenue to challenge the state’s 12-week ban by enshrining a right to abortion in the state constitution until viability (generally 24–26 weeks of pregnancy) and when necessary after that point to protect the pregnant person’s life or health.  

Abortion context:

• Nebraska’s policies are categorized as “Very Restrictive,” with a 12-week abortion ban and other restrictions.
• An estimated 2,500 abortions were provided by clinicians in Nebraska in 2023, a 15% increase since 2020.
• In 2023, 15% of abortions in Nebraska were obtained by out-of-state residents; the highest number came from Iowa (180). Nebraska residents who traveled to other states obtained abortion care in Minnesota (120), Iowa (270) and Colorado (200).

Nevada 

PASSED: Question 6 (Right to Abortion Initiative)

Led by Nevadans for Reproductive Freedom, this ballot measure enshrines a right to abortion in the state constitution until viability (generally 24–26 weeks of pregnancy) and when necessary after that point to protect the pregnant person’s life or physical health.

Abortion context: 

• Nevada’s policies are considered a mix of “Some protections and restrictions,” lacking some crucial protections.
• Nevada’s sweeping Equal Rights Amendment (ERA), passed in 2022, has also been the basis to challenge the state’s abortion restrictions. In September 2024, a Nevada state court ruled the ban on state Medicaid coverage for abortion violated the state ERA. 
• There were an estimated 16,000 clinician-provided abortions in Nevada in 2023, a 45% increase from 2020.
• This surge was partly due to an influx of patients from other states. From 2020 to 2023, the share of abortions in Nevada obtained by out-of-state residents jumped from 5% to 16%. In 2023, most out-of-state patients were residents of Arizona (1,080), Texas (860) and Utah (240).  

New York 

PASSED: Proposal 1 (Equal Rights Amendment)

Led by New Yorkers for Equal Rights, this ballot measure adds language to the state constitution to prohibit discrimination on several grounds not currently protected, including ethnicity, age, disability, pregnancy, pregnancy outcomes, reproductive health care and autonomy, sexual orientation, gender identity and gender expression.

Abortion context: 

• New York’s policies are considered “Very Protective.” 
• In 2023, an estimated 122,700 abortions were provided by clinicians in New York, an increase of 11% since 2020. State policies, such as the introduction of telehealth abortion access through New York City’s public health system, may have contributed to the increase by enabling more residents to seek care than would have been able to previously. 
• The share of abortions obtained by out-of-state residents remained consistent (5%) from 2020 to 2023. 
• Out-of-state residents from across the country obtained abortions in New York in 2023. The largest numbers were residents of New Jersey (2,540), Pennsylvania (1,020) and Florida (660), but patients also came from as far as Texas (540).  

South Dakota 

DID NOT PASS: Amendment G (Right to Abortion Amendment)

Led by Dakotans for Health, this ballot measure provides a legal avenue to challenge the state’s total abortion ban by prohibiting the state from restricting abortion in the first trimester of pregnancy. The measure outlines how the state may restrict abortion in the second and third trimesters. 

Abortion context: 

• South Dakota’s policies are categorized as “Most Restrictive,” with a total abortion ban. 
• Due to a lack of access in their state, South Dakota residents were forced to travel to Colorado (180) and Minnesota (350) for a clinician-provided abortion in 2023, and some may have traveled to other states in smaller numbers.