Abortion rights groups have been on a winning streak. Opponents hope Ohio’s Issue 1 offers a reset

By Arit John, CNN

Hamilton, Ohio (CNN) — When polls close on November 7, Ohio will either become the latest state to enshrine abortion rights into its constitution or enter a period of uncertainty as the state Supreme Court considers allowing a six-week abortion ban to be enforced.

For Joel Spring, a 33-year-old from West Chester, neither option seems ideal.

Spring said he’s “pro-life” but also thinks “we have to have some legal abortion,” with a cutoff somewhere in the first or second trimester. The state’s six-week ban went too far, he said, but so does Issue 1, a ballot initiative that would prevent the state from restricting abortion access before fetal viability, which doctors generally consider to be around 22 to 24 weeks of pregnancy.

“I think there needs to be a balance. Unfortunately, when it comes to the issue of abortion, you’re either one extreme or the other,” Spring, who voted “no” on the abortion amendment, said after casting his ballot early at his local county board of elections. “I don’t really know what the solution is.”

Ohio’s Issue 1 could drastically reshape reproductive rights in a state where Republican leaders have proposed legislation to completely ban abortion post-Roe. But it will also serve as a bellwether for 2024, suggesting what strategies and messages will resonate most with voters during a general election in which Democrats will make abortion a key issue.

After a string of defeats in last year’s midterm elections, anti-abortion groups at the state and national level hope the Buckeye State will offer a new playbook as abortion advocates seek to introduce similar initiatives to undo strict bans in other red states. Abortion opponents argue that groups such as Planned Parenthood and the ACLU, which have been working on the ballot strategy, were more prepared after the Supreme Court overturned Roe v. Wade last year and erased federal abortion protections.

“We felt it was imperative to get together with the in-state pro-life leaders and the pro-life coalitions from all across Ohio and help build a model to fight back,” said Stephen Billy, the vice president of state affairs at Susan B. Anthony Pro-Life America, an anti-abortion advocacy group. “When you work with a unified pro-life movement, alongside political leadership in the state, you have an opportunity to have an impact and defeat these amendments.”

Last year voters in Michigan, Vermont and California voted to add abortion protections to their state constitutions, while Kansas, Kentucky and Montana voters rejected efforts to roll access back. Abortion advocates are working to get initiatives on the 2024 ballot in states including Arizona, Colorado, Nevada, Florida, South Dakota and Nebraska.

In Ohio, abortion rights advocates defeated a ballot initiative in August that would have raised the threshold to amend the constitution from a simple majority to 60%. Now, after urging voters to vote “no” on the August amendment – also called Issue 1 – they are urging people to vote “yes” on the November version, a switch that has caused some confusion with voters.

Abortion opponents say that the defeat of the August measure to change the constitution – which was opposed by 57% of voters – isn’t a sign the November abortion initiative will pass. Supporters aren’t taking it that way, either.

“I don’t think you can look at any election as a given, although the vast majority of Ohioans obviously support abortion access,” said Kellie Copeland, the executive director of Pro-Choice Ohio.

As of Thursday, more than 380,000 Ohioans had cast their ballots early, according to absentee voter reports from the secretary of state’s office.

Abortion rights groups have outraised opponents and outspent them on TV. Ohioans United for Reproductive Rights, the main coalition supporting Issue 1, has raised $28.7 million for the general election, compared with $9.9 million raised by Protect Women Ohio, the main group opposing it, according to campaign finance reports filed Thursday. Since Labor Day, Democratic groups backing Issue 1 have spent more than $20 million in ads, compared with $8.5 million spent by groups opposing Issue 1, according to data from AdImpact.

The “yes” coalition sued the Ohio Ballot Board and Republican Secretary of State Frank LaRose in August over how the state described the proposed amendment on ballots, arguing the summarized text aimed to “mislead Ohioans and persuade them to oppose” it. The state Supreme Court granted the “yes” coalition a partial rewrite, but ruled against it on issues such as the use of “unborn child” over “unborn fetus” and the summary’s exclusion of the proposed amendment’s protections for contraceptive care.

Unlike Michigan, which had a Democratic governor, secretary of state and attorney general when it passed a very similar abortion rights amendment last year, Ohio Republicans have trifecta control of the government, and run the offices of attorney general and secretary of state. Those leaders have been deeply involved in trying to defeat the measure.

Gov. Mike DeWine, who won reelection last year by 25 points against a Democrat who supported abortion access, cut a TV ad urging Ohioans to vote “no” on Issue 1, which he’s said is too extreme for the state. Attorney General Dave Yost released a legal analysis of the amendment that argued it went “further” than the protections in Roe and could overturn parental consent laws for minors seeking abortions.

Nationally, the state’s anti-abortion coalition has received more than $15 million from Susan B. Anthony Pro-Life America for both the August and November Issue 1 initiatives, according to campaign finance records.

Under current Ohio law, abortion is legal before 22 weeks of pregnancy. But that could change depending on the fate of a six-week abortion ban signed into law by DeWine in 2019. The “heartbeat bill,” which bans the procedure after fetal cardiac activity is detected, was blocked by a federal court at the time. The court then, at the behest of Yost, lifted the injunction against the law hours after the Supreme Court overturned Roe.

The six-week ban, which included no exceptions for rape or incest victims, was in effect from June to September 2022, before it was paused by a court. Among those affected was a 10-year-old rape victim who had to travel to Indiana to get an abortion. It’s now being considered by the state Supreme Court.

“It has really helped illustrate what a ‘yes’ vote means,” Jordyn Close, the deputy director of the Ohio Women’s Alliance, one of the groups in the coalition backing Issue 1, said of the six-week ban. “We’re able to say Ohio has experienced this already. Ohio doesn’t want to go back to this.”

Opponents have tried to frame Issue 1 as an extreme in the other direction.

“People have very differing views about at what point in a pregnancy abortion should be permitted, but a very small number of people think that abortion should be permitted at all times, up until the time of birth,” DeWine said in an interview with CNN. “They’ve just grossly overreached.”

Issue 1 does allow abortion to be prohibited after fetal viability, a point determined by the pregnant patient’s treating physician. However, there are no circumstances under which abortion can be prohibited if the presiding physician deems it “necessary to protect the pregnant patient’s life or health.”

Under the state’s six-week ban, abortions are allowed after fetal cardiac activity is detected if the patient’s physician believes one is necessary to “avoid a serious risk of the substantial and irreversible impairment of a major bodily function of the pregnant woman” or to prevent the patient’s death.

Most abortions are induced during the first three months of pregnancy. Of the 21,813 abortions performed in Ohio in 2021 — the year before the six-week ban briefly went into effect — about 87% were performed before 13 weeks of pregnancy, according to data from the Ohio Department of Health.

Less than 1% were performed after 20 weeks, and none were performed after 24 weeks. The number of abortions in Ohio dropped 15% between 2021 and 2022, according to the department.

DeWine and other Issue 1 opponents have sought to separate the six-week bill from the debate over the ballot initiative, arguing it’s easier to change a state law than it is to amend the state constitution.

“If we can defeat this amendment, which I certainly hope we can, it will give us the opportunity in Ohio to try to come up with something that the majority of Ohioans can support,” DeWine said in an interview. He said a new bill should include exceptions for rape and incest, and that the timeline of the restriction is “certainly something to be discussed.”

But abortion rights advocates say they worry Republicans would go even further than the six-week ban and prohibit all abortions as some states, including neighboring Indiana, have done.

“I have no doubt they will go forward with [a total ban], because that’s always been their agenda,” said Copeland of Pro-Choice Ohio. “That’s really what’s at stake with Issue 1.”

While the “yes” side has pointed to the six-week limit, the “no” side has pointed to Michigan, where Democratic lawmakers have advanced a slate of bills designed to repeal other existing abortion regulations.

“They are providing this perfect test case for us to look at and see what will come to Ohio if Issue 1 passes,” said Amy Natoce, a spokesperson for Protect Women Ohio.

After Michigan enshrined abortion rights in the state constitution and Democrats won control of government, state lawmakers introduced a package of bills aimed at dropping remaining abortion policies they viewed as restrictive, such as the state’s 24-hour waiting period and informed consent form requirement and other requirements targeted at abortion clinics.

Abortion rights advocates say the regulations are unnecessary hurdles designed to dissuade patients or make it harder for clinics to operate. Opponents say such regulations are about patient safety.

In both Michigan and Ohio, abortion opponents argued the constitutional amendments would also eliminate parental consent laws in the state.

So far, that hasn’t come to pass in Michigan.

While abortions rights advocates have called the consent law unnecessary or outdated, Democratic lawmakers have not introduced legislation to repeal it.

For Shannon Gracen, a 52-year-old from Symmes Township near Cincinnati, it wouldn’t be a bad thing if Ohio followed in Michigan’s footsteps.

“Republicans are saying, what a mess it is in Michigan because they did this last year,” Gracen said. “And it’s just lies.”

Gracen took her two adult daughters with her to vote early recently, and all three voted “yes” on Issue 1.

“We voted ‘yes’ because we want to make sure that women have rights,” she said.

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CNN’s David Wright and Ethan Cohen contributed to this story.