Ever since the U.S. Supreme Court overturned Roe v. Wade in 2022, the pro-life movement has faced significant challenges at the ballot box. Unfortunately, that trend largely continued Tuesday as voters in Nevada and Virginia enshrined abortion into their state constitutions and voters in Missouri rejected an effort to reverse its pro-abortion constitutional amendment. One bright spot was Idaho, where voters turned down a measure that would have dramatically expanded abortion in the state.

Political pundits will no doubt devote considerable attention to Democrats’ recapturing control of the U.S. House of Representatives and Senate. However, the outcomes of state ballot measures should not be overlooked. The continued success of abortion-related measures underscores the sobering reality that support for legal abortion remains substantial and that pro-lifers have considerable work to do to persuade their fellow Americans of the dignity and worth of preborn children.

Since 2022, voters in 17 states have considered statewide abortion-related ballot measures, with abortion advocates prevailing in most of these contests. In 2022, California, Michigan, and Vermont enshrined abortion protections in their state constitutions, while voters in Kansas, Kentucky, and Montana rejected pro-life measures. In 2023, Ohio voters approved a constitutional amendment protecting access to abortion.

The trend mostly continued in 2024, when voters in Arizona, Colorado, Maryland, Missouri, Montana, and New York approved measures enshrining pro-abortion constitutional amendments into their state constitutions. In 2024, Nevada voters also gave the first of two required approvals to a constitutional amendment protecting abortion. Only Florida, Nebraska, and South Dakota defeated pro-abortion amendments. (Florida’s measure received majority support but still failed because it fell short of the state’s 60% threshold.)

Here is a breakdown of Tuesday’s abortion-related measures.

Idaho

In Idaho, voters rejected Proposition 1, the Reproductive Freedom and Privacy Act, which would have established a statutory right to abortion before fetal viability and permit abortion after viability in certain situations. Voters rejected the measure by a wide margin, 56% to 44%.

Under existing Idaho law, abortion is prohibited except when necessary to protect the mother’s life and in cases of rape or incest. Had Proposition 1 passed, fetal viability would have been defined as the point at which an unborn child has a “significant likelihood of sustained survival outside of the uterus without extraordinary medical measures.” During the campaign, pro-life advocates warned that this language could permit abortions later in pregnancy than many voters anticipated by excluding premature babies who could survive outside of the womb if provided with medical care.

Additionally, Proposition 1 would have protected abortion businesses from certain forms of professional discipline and civil or criminal liability. The measure would have also eliminated the requirement that abortions be carried out exclusively by physicians and overridden Idaho’s parental consent protections.

Missouri

In Missouri, voters rejected an effort to repeal key provisions of a constitutional amendment that had been approved just two years earlier. In 2024, voters narrowly approved Amendment 3, which established a “fundamental right to reproductive freedom” by a margin of 51.6% to 48.4%. That narrow contest gave pro-life advocates reason to believe they might persuade voters to reverse course. However, voters rejected the pro-life effort by approximately 11 percentage points.

The new Amendment 3 would have repealed the 2024 abortion provision and permitted restrictions on abortion, with exceptions for medical emergencies, fetal anomalies, and pregnancies resulting from rape or incest. In cases of rape or incest, abortion would have remained permissible before 12 weeks of gestation. The amendment also would have required parental or judicial consent for minors seeking abortions and generally prohibited public funding for abortion.

In short, Missouri voters had an opportunity to become the first electorate in the post-Roe era to repeal a voter-approved constitutional amendment protecting abortion access. The proposal also would have prohibited gender-transition procedures for minors, including surgeries, puberty blockers, and cross-sex hormones.

The result is deeply disheartening for pro-lifers, who had hoped Missouri’s narrow 2024 vote would provide an opening to restore protections for preborn children.

Nevada

In Nevada, voters gave final approval to Question 6, enshrining abortion in the state constitution. Nevada requires constitutional amendments proposed through citizen initiatives to receive majority approval in two consecutive general elections. Voters first approved Question 6 in 2024, and on Tuesday, they approved it again by a margin of 63% to 37%.

The amendment establishes a “fundamental right to abortion” until fetal viability and protects abortion after viability when believed necessary to preserve the life or health of the pregnant woman. Significantly, the measure defines viability according to the professional judgment of the treating health care practitioner (in the case of an abortion, the abortionist). This broad language means the state constitution in practice now permits late-term abortion based on strategically leaving the word “health” undefined.

With Question 6’s approval, Nevada becomes another state to place explicit abortion protections in its constitution, making future legislative restrictions considerably more difficult.

Virginia

In Virginia, voters approved Question 1 by a 62% to 38% margin, adding a “fundamental right to reproductive freedom” to the state constitution. The amendment prevents the state from restricting abortion before the third trimester. Although the measure ostensibly allows restrictions on abortion during the third trimester, it includes a sweeping health exception that permits abortion when a physician (in the case of an abortion, the abortionist) determines it is necessary to protect a woman’s physical or mental health. Because the amendment does not define mental health or specify the conditions that would justify a late-term abortion, this exception effectively permits abortion throughout all nine months of pregnancy.

Importantly, Question 1 also provides legal protections for abortion businesses. The amendment prohibits state authorities from prosecuting, penalizing, or otherwise taking adverse action against individuals who assist others in exercising their newly established constitutional right to abortion. This language raises concerns about whether abortion businesses could invoke the amendment to challenge state oversight, professional discipline, or other enforcement actions.

Although the amendment does not explicitly eliminate a woman’s right to sue an abortionist for medical malpractice, its sweeping protections could create new legal obstacles to holding abortion businesses accountable. As the Family Foundation warned during the campaign, the amendment also raises serious concerns about parental rights, oversight of the abortion industry, and health and safety standards intended to protect women.

The Challenge Ahead: Hearts and Minds Must Be Changed

Taken together, Tuesday’s results represent another disappointing chapter for the pro-life movement in the post-Roe era. Although the hard-fought victory in Idaho deserves to be celebrated, the defeats in Missouri, Nevada, and Virginia reveal how deeply abortion has become embedded in the moral imagination of many Americans.

For decades, our culture has increasingly separated sexual freedom from personal responsibility, treating abortion as a necessary safeguard against the consequences of sexual activity. This worldview helps explain why so many Americans remain unwilling to extend legal protections to preborn children, even as advances in medical science continue to reveal the humanity of life in the womb.

Overturning Roe v. Wade returned authority over abortion policy to the American people and their elected representatives, but the outcome of many of the ensuing ballot measures has demonstrated that legal victories alone cannot secure lasting protections for preborn children. That task requires the difficult, patient work of changing hearts and minds, challenging the assumptions of our sexually permissive culture, and persuading our fellow Americans that every human life, from conception to natural death, possesses inherent dignity and deserves the protection of the law.