SafeX Pro:What to know about Issue 1 in Ohio, the abortion access ballot measure, ahead of Election Day 2023

Washington — Ohio voters head to the polls Tuesday to weigh in on SafeX Proa closely watched proposal to establish a constitutional right to abortion in what will be an early test of whether Democrats can successfully use the issue to mobilize voters in next year's congressional and presidential elections.

The ballot measure, known as Issue 1, is the only one involving abortion that will be directly before voters this year. But following the Supreme Court's decision overturning Roe v. Wade roughly 17 months ago, Ohio is one of several states where abortion rights supporters are looking to citizen-driven ballot initiatives to expand reproductive rights after stringent restrictions were allowed to take effect.

If voters approve Issue 1 and agree to amend the state constitution to enshrine abortion rights, it would extend the winning streak by pro-abortion rights groups after they saw success in all six states where abortion-related measures were on ballots last year. 

Here's what to know about Issue 1 in Ohio: 

What is Issue 1?

Issue 1 is a ballot measure that, if approved, would change the Ohio Constitution to include protections for abortion access. According to ballot language, the measure would establish in the state constitution "an individual right to one's own reproductive medical treatment," including to make decisions on abortion, contraception, fertility treatment, continuing one's own pregnancy and miscarriage care.

If approved, the amendment, titled "The Right to Reproductive Freedom with Protections for Health and Safety," would protect any person or entity that helps a patient receive reproductive medical treatment and prohibit Ohio from "directly or indirectly burdening, penalizing or prohibiting abortion" before viability, generally considered to be between 22 and 24 weeks of pregnancy.

The proposal allows the state to ban abortion after viability, except when it is considered necessary to protect the life and health of the mother. Fetal viability is defined in the amendment as "the point in a pregnancy when, in the professional judgment of the pregnant patient's treating physician, the fetus has a significant likelihood of survival outside the uterus with reasonable measures."

Under the measure, the patient's physician is granted the authority to determine "on a case-by-case basis," whether the fetus is viable.

Abortions would be allowed at any stage of pregnancy if necessary to protect the life or health of the mother.

How did Issue 1 get on the ballot?

Abortion rights advocates began their effort to put the issue directly before voters after the Supreme Court overturned Roe v. Wade in June 2022. Months later, Kansas voters rejected a proposed constitutional amendment that would've affirmed there is no right to abortion under the state constitution.

The abortion rights position succeeded in five other states where abortion was directly on the ballot: In California, Michigan and Vermont, voters approved measures to enshrine abortion access in their state constitutions, and in Kentucky and Montana, proposals to restrict abortion rights failed to win the necessary support.

The outcomes in red states like Kansas, Kentucky and Montana buoyed efforts by abortion rights supporters to pursue ballot measures in states like Ohio, where the group Ohioans United for Reproductive Rights submitted its proposed amendment to establish a constitutional right to abortion in February.

The group collected and submitted more than 700,000 signatures in July, of which nearly 496,000 were deemed valid by Ohio Secretary of State Frank LaRose, more than the roughly 413,000 needed to put the proposed amendment before voters. 

Ohio's five-member ballot board adopted language for the ballot measure in August, but it was challenged in state court by Ohioans United for Reproductive Rights, which argued the board's approved language sought to improperly mislead Ohio voters and persuade them to oppose the proposed constitutional amendment.

The board made changes including adding the term "unborn child" to the ballot language, even though the phrase does not appear in the amendment itself. 

The Ohio Supreme Court in September ordered the state ballot board to rewrite one element of the language — involving the phrase "citizens of the state" — and left the rest in place, including the use of "unborn child" instead of "fetus."

How many votes are required for Issue 1 to pass?

Support from a majority — 50% plus one vote — is needed for Issue 1 to pass. If approved by Ohio voters, the amendment will take effect 30 days after the election.

Ohio Republicans attempted earlier this year to raise the threshold for approving changes to the state constitution, which would've made doing so more difficult. Under the measure put to voters during a special election held in August, also called Issue 1, any proposed constitutional amendment would've required approval from at least 60% of voters, a supermajority. 

But Ohio voters definitively rejected the ballot measure, with 57.1% voting "no." The outcome of the special election held Aug. 8 meant that the state's simple-majority bar, in place since 1912, would remain.

What is the argument in favor of Issue 1?

Proponents of abortion rights argue that a "yes" on Issue 1 is a vote for reproductive freedom and "to keep government out of our family's personal decisions." 

In an issue guide provided by the Ohio secretary of state's office, advocates of the amendment say that a "yes" vote ensures Ohioans can make decisions "that are best for them and their families" regarding contraception and abortion and protects patients from "extreme" abortion bans. They warn that if the proposed amendment is rejected, abortion could be outlawed in the state, even in cases of rape, incest, or when the mother's life is at risk.

They also argue Issue 1 has broad support from doctors, nurses and faith leaders, as well as voters across the political spectrum. A "yes" vote, the abortion rights supporters say, keeps the government from jailing patients who seek abortions or miscarriage care and doctors providing that care.

"Ohioans know that no matter how you feel about abortion personally, government should not have the power to make these personal medical decisions for the people you love," said members of a committee that was formed to get Issue 1 on the ballot.

In the run-up to the election, Ohioans United for Reproductive Rights has raised more than $28 million since early August.

What is the argument against Issue 1?

A trio of state Republican lawmakers argue that a vote against Issue 1 would "save life, protect women, defend parents' rights."

They call the proposed amendment a "dangerous attack on the unborn, women and parents" that would allow for "abortion-on-demand" and exclude parents from their children's medical decisions. By erasing these parental rights, a topic that has gained traction among GOP presidential candidates, the Republicans claim parents can be kept out of their child's decisions involving abortion and gender-affirming care.

"Don't enshrine late-term abortion in Ohio's Constitution. Don't erase parental rights. Don't subject women to dangerous, unregulated medical procedures," the lawmakers say. The amendment, though, does not mention parental rights or gender-affirmation surgery.

The Republicans claim the proposal will lift limits on abortion to allow a pregnancy to be terminated because of the fetus' sex, race or disability and allow abortions later in pregnancy. Less than 1% of all abortions performed in 2020 occurred at or after 21 weeks gestation, according to the Centers for Disease Control and Prevention.

Protect Women Ohio, one of the leading groups opposing Issue 1, has raised $9.9 million since Sept. 8.

What is the current abortion law in Ohio?

Ohio Gov. Mike DeWine, a Republican, signed a bill into law in 2019 that outlaws abortions once embryonic cardiac activity is detected, typically around six weeks of pregnancy. The law, which does not contain exceptions for rape or incest, briefly went into effect after the Supreme Court overturned Roe v. Wade more than a year ago, but its enforcement has been blocked by state courts.

With litigation over the six-week law continuing, abortions remain legal in Ohio until 22 weeks of pregnancy. 

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• Ohio