The role of state ballot initiatives in abortion policymaking has peaked, Lantz says | Gerald R. Ford School of Public Policy

The role of state ballot initiatives in abortion policymaking has peaked, Lantz says

December 18, 2024

Since the 2022 Supreme Court decision in Dobbs v Jackson Women’s Health Organization, state ballot measures, which allow citizens to vote on state constitutional amendments and laws, have become a significant form of abortion policymaking. Paula Lantz, the James B. Hudak Professor of Health Policy, examines the current and future impacts of these measures on abortion access in the Milbank Quarterly.

Following the Dobbs decision, voters in 16 states have considered 18 different ballot initiatives related to abortion care. Lantz discusses how 13 successful initiatives either enshrined or expanded rights to abortion and other reproductive care services in the state constitution or prevented legislators from amending state constitutions to deny reproductive care rights. Despite the current trend in favor of pro-choice ballot initiatives, Lantz argues that their role in shaping abortion policy will likely diminish for several reasons:

  1. Only two of the pro-choice ballot initiatives that have passed to date have substantially impacted existing state law (Michigan and Ohio). 
  2. Not all states permit citizens to initiate ballot measures. Among the remaining states with restrictive abortion policies, only four give citizens the power to place constitutional amendment proposals on the ballot (Arkansas, Florida, Mississippi, Oklahoma), and efforts in three of these states have already failed. 
  3. Although the November, 2024 elections saw a record 159 ballot measures in 41 states, there is a growing movement to make it more difficult for citizens to get initiatives on the ballot and for those initiatives to pass.
  4. The 119th Congress and new Trump administration have several avenues for enacting restrictive abortion policies. Beyond potential national legislation that places limits and restrictions upon states, sources such as Project 2025 reveal a long-game playbook for anti-abortion policy that circumvents state constitutions and public opinion, focusing executive and judicial branch action.

Lantz concludes that the impact of citizen-initiated state ballot measures has likely reached its peak. “Without a new Supreme Court decision that restores some level of federal constitutional protection across states, abortion policy battles will continue to rage across levels and branches of government. Amid these public policy battles, the consequences for women, children and families are dire.” 

>>Read “The Role of State Ballot Initiatives in Abortion Policymaking has Peaked” in Milbank Quarterly.