Celina Washburn protests outside the Arizona Capitol to voice her dissent with an abortion ruling, Friday, Sept. 23, 2022, in Phoenix. AP Photo/Matt York, File

Abortion rights advocates are exploring ballot measures to enshrine access to the procedure into state constitutions in 2024, including in a handful of Republican-led states with restrictions on the books.

The effort represents an emerging strategy for the abortion rights movement and a growing belief that public opinion is on their side. After the Supreme Court overturned the constitutional right to an abortion, advocates know appealing directly to voters is one of the only ways to counteract bans in conservative states and reshape access in a post-Roe America.

While in the early stages, discussions around whether to pursue an abortion rights ballot measure are occurring in states including Ohio, Florida, Arizona, Oklahoma, Colorado and Missouri, according to interviews with over a dozen advocates, liberal groups and others, some of whom spoke on the condition of anonymity to detail private conversations. One person familiar with the discussions said at least a dozen states are exploring – or are expected to soon explore – whether a citizen-led petition is a viable path to restoring or protecting abortion access in their state.

“Every state that has access to direct democracy as a tool will consider if that is a strategy that makes sense for 2024, for 2026 and beyond,” said Sarah Standiford, the national campaigns director at Planned Parenthood Action Fund. But she cautioned that research and analysis will ultimately determine whether state advocates decide to move forward.

Some abortion rights advocates warn the movement should proceed carefully, wary of pouring millions of dollars into a ballot measure campaign only to be defeated. Such endeavors can take years to plan and are resource intensive, involving copious cash, research and time. Meanwhile, some Republican-led states are fighting back against ballot measures, seeking to make it more difficult to pass such initiatives after liberal policies – from expanding Medicaid to raising the minimum wage – have won in conservative-leaning states across the country.

But an unexpected Kansas victory has already provided a test case of how ballot measures may be useful in the future.

In early August, roughly 59 percent of voters in Kansas defeated an attempt to strip abortion protections from the state constitution – a margin of victory that shocked both sides of the debate. The campaign opposing the measure used messaging it believed could appeal to voters across the political spectrum such as focusing on the freedom of Americans to make their own health-care decisions without government interference, a message Republicans typically use to promote their own health agenda.

An anti-abortion advocate along with abortion rights advocates hold up signs during the Emergency Pro-Life Rally for New Mexico in Las Cruces, N.M., on Tuesday, July 19, 2022. Meg Potter/The Las Cruces Sun News via AP, File

The vote in the conservative state where President Donald Trump won by 56 percent shows “we can do this,” Corrine Rivera Fowler – who served as the policy and legal advocacy director at the Ballot Initiative Strategy Center, which helps with liberal ballot measures – said in an August interview before leaving her post late last month. “We can use the tool of the ballot measure to protect our right to make decisions over our body.”

Even before the Kansas vote, some abortion rights supporters began eyeing the ballot box as a critical tool shortly after the Supreme Court overturned the nearly half-century-old constitutional right to an abortion in June.

“Conversations immediately started stirring,” said one person in the reproductive health movement granted anonymity to detail private conversations. “Can we do this? Can we make this happen?”

A major test comes in November, where abortion will be on the ballot in five states. In particular, Michigan – a swing state – is viewed as a bellwether for future ballot measures aimed at shoring up abortion rights in other purple states.

Not every state allows questions to be posed directly to voters. Roughly half of states have processes allowing citizens to gather signatures and petition to put questions on the ballot. But only 18 states allow voters to directly amend their state constitutions through such petitions, according to the National Conference of State Legislatures, further limiting the areas where abortion rights supporters can attempt to restore access to the procedure.

In most states, no decisions have been made. The discussions occurring across the country are preliminary, but groups such as the Ballot Initiative Strategy Center advise state advocates to begin exploring the idea at least two years in advance.

Such considerations include the legal and political landscape in a given state, the sheer cost of mounting a campaign, whether the idea has broad support among a diverse coalition of groups and research into if the state’s public will vote for such a measure. They’ll face fierce opposition from the antiabortion movement and other conservatives in the state, who could pursue lawsuits to attempt to stop the initiatives or mobilize their resources to try to defeat the measure at the polls.

“We are going to pay attention,” said Stephen Billy, the vice president of state affairs at SBA Pro-Life America. “We are going to be on the front end of these things in all the states and are aware of the threat and are going to do everything that we can to fight back where we’ve got the ability to.”

In Colorado – where abortions are legal – advocates have been plotting a ballot measure for over a year aimed at affirming the right to an abortion in the state’s constitution, as well as allowing state funds to pay for abortions, according to Karen Middleton, the president of Cobalt Advocates, a reproductive rights group.

“We for many years have been looking at a proactive ballot measure, and the reason we have held off was there’s been a hesitancy about how much it will cost and how much it takes out of our relatively small organizations that are doing other work,” Middleton said.

But now, a coalition of seven groups believes the time is right and is in the process of hiring initial staff to prepare for a 2024 campaign. At least 2 percent of total registered voters in each of the 35 Colorado Senate districts must sign a petition to get the abortion protections on the ballot, in addition to other requirements. Roughly 56 percent of surveyed Coloradans said abortion should be legal in all or most cases, compared with 38 percent who said it should be illegal in all or most cases, according to the Public Religion Research Institute’s American Values Atlas in 2018, when the nonpartisan group last asked about abortion rights.

Abortion-rights protesters fill Indiana Statehouse corridors outside legislative chambers on Aug. 5, 2022, as lawmakers vote to concur on a near-total abortion ban, in Indianapolis. AP Photo/Arleigh Rodgers, File

Support for abortion rights was similar in Arizona, Florida and Ohio, hovering around 56 percent. It was a little lower in Missouri and Oklahoma, at 49 percent and 47 percent, respectively.

In Ohio, a ballot measure is “certainly possible” for 2024, though discussions are still fluid on what year advocates would potentially seek to put a question to voters, according to Lauren Blauvelt-Copelin, the vice president of government affairs and public advocacy for Planned Parenthood Advocates of Ohio.

Since the Supreme Court overturned Roe v. Wade in June, abortion access in Ohio whipsawed between a ban on most abortions to resuming the procedure temporarily. A Hamilton County judge recently paused enforcement of the state’s ban on abortion after fetal cardiac activity is detected while the case winds its way through the courts. Yet, antiabortion advocates are pushing the legislature to adopt further restrictions during a lame-duck session in November, believing the electorate won’t sign off on a constitutional amendment supporting abortion access.

“I don’t see Ohio being in play for them,” Mike Gonidakis, the president of Ohio Right to Life. “And if they do bring the initiative and it says, ‘no limits, no restrictions,’ we’ll beat it 80[percent]-20[percent].”

A simple majority of votes is needed to pass such a measure in Ohio. But in other states, that threshold is higher.

In Florida, an amendment to the constitution must garner 60 percent support at the ballot box as of 2006, increasing the difficulty of passing abortion measures.

There’s a grass-roots effort underway in the state to ask voters to adopt a constitutional amendment “recognizing the God-given right to life of the preborn individual,” which would need to collect nearly 892,000 signatures to put the question to voters in 2024. A broader measure failed to garner enough signatures for the 2022 ballot, but Mark Minck, the state chairman for Protect Human Life Florida, said he tailored the question this time to solely focus on abortion after the Supreme Court overturned Roe.

On the other side, there are preliminary conversations occurring around a potential measure to instead protect abortion access in the state, which currently has a 15-week ban on the procedure, said state Rep. Anna Eskamani, a Democrat who previously worked for Planned Parenthood of Southwest and Central Florida.

“We’re navigating a ballot amendment initiative opportunity in a state that has already made this process more difficult,” she said. “So we have to tread in a very intentional and strategic way.”

The potential for citizen-led initiatives to become harder to pass already has abortion rights advocates on edge. In Oklahoma, that’s a fear among those who have begun discussing whether to attempt a constitutional amendment amid the state’s ban on abortions with limited exceptions.

“We need to do more due diligence because we can’t afford to get it wrong,” said one reproductive justice advocate in Oklahoma, who spoke on the condition of anonymity to detail private conversations.

In Arizona, a last-minute grass-roots effort to put an abortion rights measure to voters in November failed to garner enough signatures over the summer.

Now, there are exploratory conversations underway about whether to attempt such an effort for 2024, though the decision partly depends on the outcome of several measures on the state ballot this year that could make such campaigns more difficult, according to Darrell Hill, policy director of the American Civil Liberties Union of Arizona. On Friday, an Arizona appellate court halted enforcement of the state’s near-total ban on abortion, which was rooted in a law from 1864. Now, most abortions in the state are prohibited after 15 weeks.

After the midterms, conversations around future abortion-related ballot measures will intensify, as groups on the ground grapple with deciding whether to test the waters.

“We know that the majority of Missourians support access to abortion without political interference, and we have a strong coalition of organizations on the ground who are committed to protecting these basic rights,” said Mallory Schwarz, the executive director of Pro-Choice Missouri. “Right now, everything is on the table.”