On the eve of a potentially historic presidential election, Natasha Sutherland is tired. The born-and-raised Floridian and senior advisor to the Yes on 4 campaign has been fighting to expand and protect abortion access in her home state for years, but that fight hit a fever pitch after the Supreme Court overturned Roe v. Wade in 2022. 

“We knew that lawmakers in the state of Florida were going to implement an abortion ban,” Sutherland said. “And we knew there was something we had to do about it—we knew [a ban] would be an immense and significant loss of care both to the state of Florida and the global South.” 

Florida is just one of 10 states with ballot measures that will give voters the opportunity to enshrine abortion rights in their constitutions. Since the fall of Roe, 21 states have banned or severely restricted abortion—and the consequences have been far-reaching. A recent study published in JAMA Pediatrics found that infant mortality rates have risen in states with total or near-total abortion bans. In Texas, where abortion is banned with no exceptions for rape or incest, maternal mortality rose by 56%. In Georgia, at least two women so far—Amber Nicole Thurman and Candi Miller—have died as a result of the state’s six-week abortion ban.

Meanwhile, the post-Roe crisis is forcing patients with means to travel out of state for abortion, prenatal, and miscarriage management care, resulting in backlogs in states where abortion rights are protected. In 2023 alone, 171,000 women traveled to another state to receive abortion care. 

These ballot measures, organizers and advocates hope, could bring back abortion access to what has become an “abortion and maternal care desert.”

With the writing on the proverbial wall after the draft of the Dobbs decision leaked, Sutherland and other organizers from Floridians Protecting Freedom immediately got to work—creating partnerships with the ACLU of Florida, Planned Parenthood, Florida Women’s Freedom Coalition, Florida Rising, and more. The collective began drafting amendment language and collecting signatures for ballot measure Amendment 4, which would prohibit the government from outlawing, penalizing, delaying, or restricting abortion care before fetal viability.

“We secured nearly 1 million verified signatures of everyday Floridians—Republicans, Democrats, Independents—to qualify for the ballot,” Sutherland adds. “That was well above the requirement because we knew the government may try to interfere.” 

The organizers’ premonitions proved correct. In April 2023, Gov. Ron DeSantis signed the state’s six-week abortion ban into law. DeSantis has since directed the state’s health department to threaten television stations with criminal charges if they continue to air pro-abortion measure ads. Simultaneously, the state’s Office of Election Crimes and Security claimed the group submitted a “large number of forged signatures or fraudulent petitions” to qualify for the ballot and issued a $328,000 fine.

“Florida’s government has been doing everything and anything that it can to really silence the campaign and to distract folks from the fact that we have a near-total abortion ban here in the state of Florida,” Sutherland said. “Just as we were preparing for Hurricane Helene and subsequently Hurricane Milton, the state government ordered $15.5 million in taxpayer-funded advertising—much of that going towards campaigning against Amendment 4 and putting out misinformation about the abortion ban and the campaign overall.” 

For the amendment to pass, it must receive 60% or more of the vote, a higher threshold requirement than any other state in the country. Recent polling shows the amendment has a 66% approval rate.

As is the case in Florida, many anti-abortion groups and legislators across the country are attempting to curtail those efforts, spreading disinformation about the proposed amendments and attempting to circumvent the democratic process in court. 

In South Dakota, Life Defense Fund has filed a lawsuit that would invalidate Amendment G, an abortion rights measure that would codify Roe v. Wade-era abortion protections in the state’s constitution. A trial is set for Dec. 2. 

“What they’re trying to do is direct the court to tell the secretary of state, ‘You can’t count the votes,’” said Rick Weiland, a long-time Democrat and former candidate for Congress. Weiland and his son, Adam, co-founded Dakotans for Health, the grassroots organization behind the ballot measure.

South Dakota is the only state with a total abortion ban to propose amending the state’s constitution to protect abortion access. Immediately after the Supreme Court overturned Roe v. Wade, the state enacted its trigger law, banning all abortions with no exceptions for rape or incest. Currently, abortion is only permissible if the life of the pregnant person is in danger, but like other states that have banned or severely restricted abortion care, post-Roe doctors are confused by the vague exception language and afraid to treat pregnant or miscarrying patients. 

In a state with already high infant and maternal mortality rates, patients are forced to travel to nearby Minnesota or beyond for an abortion, prenatal care, and miscarriage management. The state is simultaneously experiencing a maternal care shortage due in part to OB-GYNs either leaving or choosing not to practice in a state that would criminalize them if they were even perceived to have defied the state’s abortion ban. 

“My cup runneth over in terms of the rage factor,” Adam said. “But stuff like this, it makes you more determined to succeed.”

Consistent polling has shown that the majority of South Dakotans, regardless of party affiliation, support the ballot initiative, which would allow unfettered abortion access in the first trimester, with government-regulated abortion access in the second and third trimesters in ways that are, according to the bill, “reasonably related to the physical health of the pregnant woman” or “when abortion is necessary to preserve the life of the pregnant woman.” A group of Republicans, led by former legislator Casey Murschel, have come out in support of the measure, along with 35 faith leaders from five different Christian denominations.

“Writing off red states where we have an opportunity to expand abortion access is extremely short-sighted. South Dakota is a perfect example,” Adam said.

South Dakota was the first state to include direct democracy in its constitution, giving the electorate the power to circumvent the special interests, bypass the legislature, and put something on the ballot that lets the people decide “yes” or “no.” Empowered by that history, both father and son are hopeful that despite anti-abortion groups’ best efforts, voters will restore Roe v. Wade in the state.

“All you have to do is look at past initiatives,” Rick said. “They will tell you a lot about the makeup of the voter.” 

Arizona, which made national news after the Supreme Court allowed a near-total abortion ban from 1864 to take effect on Sept. 14, also gives voters the power to implement state policy via direct democracy. In this upcoming election, Arizona voters will weigh in on Proposition 139, which would enshrine abortion protections in the state’s constitution. 

The state’s legislature eventually repealed the 160-year-old ban in May. Abortion is currently legal up to 15 weeks gestation, with no exceptions for rape or incest. If passed, Proposition 139 would expand abortion access to the “point of viability” and grant the right to care after viability “if it is done to protect the life, physical, or mental health of the pregnant individual.” 

“This was the largest volunteer signature gathering effort in the history of the state,” said Laura Dent, the political director for Arizona For Abortion Access and the campaign manager for Yes on 139. “It sends a super clear message—not just as we move into the election, but beyond—that this is an issue Arizonans are united around.” 

Like in Florida and South Dakota, in Arizona Dent and her volunteers have withstood attacks from anti-abortion groups attempting to undermine the amendment. After Arizona Abortion Access received 577,971 certified signatures in favor of the amendment—well above the 383,923 signatures needed—Arizona Right to Life filed a legal challenge to the ballot initiative, arguing the petition description was misleading and requesting the measure be withdrawn. 

“This is a really important moment, [not] just for the issue of abortion rights but for our freedoms, protecting our liberties, and just for organizing in the state,” Dent said. “We have a beautiful, diverse coalition. I spent the day with Navajo leaders. We have environmental advocates, faith-based leaders, [and] Latino-led organizations. Our coalition is really broad, because this is such a resonant issue and a powerful exercise for Arizonans.” 

In August, Arizona state’s Supreme Court rejected the anti-abortion group’s attempt to block the amendment, ruling that a description “is not required to explain the initiative’s impact on existing abortion laws or regulations.” The amendment is expected to pass. A recent New York Times/Siena College poll found that 58% of Arizona voters support the fundamental right to an abortion.

“We have kept 100% of our focus on educating and engaging voters and telling the stories of everyday Arizonans who have been impacted by the state’s ban, and really try to avoid getting pulled into conversations and distractions that try to frame this as a controversial issue,” Dent said. “The majority of Arizonans are with us. The majority of Americans are with us.” 

While every state faces its own unique challenges, the organizers all agree that passing their respective amendments is only the start of the battle. 

“We discovered over the last decade that if you get something on the ballot, and it’s able to pass, you also have to be able to hang around once you go into overtime to defend it and implement it,” said Adam Weiland of Dakotans for Health. “Things just don’t stop after you win. This law goes into effect in July of next year if it passes, and I’m sure — knock me over with a feather if there’s not—there will be attempts to undermine the law.” 

“But we will be there to fight it every step of the way,” he added.

And when the organizers grow tired and the anti-abortion attacks feel overwhelming, they all say they remember the stories of people impacted by their states’ anti-abortion laws.

In moments of fatigue, Sutherland said she thinks of Deborah Dobert, who was forced to carry her nonviable pregnancy to term. As a result, she held her baby boy in her arms as he died. She also thinks about Anya Cook, who lost half the blood in her body before she was able to receive the life-saving abortion care she needed. 

“These are Florida women,” Sutherland said. “These stories allow people to really understand that we’re not talking about the issue of reproductive health care as a hypothetical. We all understand that no politicians, regardless of party, should make decisions for us. So I am cautiously optimistic that we will see this through November, and I welcome whatever comes after that.”

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