Referendum to enshrine abortion and contraception in the state constitution
The 2023 Ohio reproductive rights initiative, officially titled "The Right to Reproductive Freedom with Protections for Health and Safety" and listed on the ballot as Issue 1, was a citizen-initiated constitutional amendment adopted on November 7, 2023, by a majority (56.8%) of voters. It codified reproductive rights in the Ohio Constitution, including contraception, fertility treatment, miscarriage care, and abortion up to the point of fetal viability, restoring "Roe v. Wade"-era access to abortion in Ohio.
In 2019, the state legislature passed a six-week ban on abortion in Ohio, without exceptions for rape or incest. The statute became active after the Supreme Court of the United States held in "Dobbs v. Jackson Women's Health Organization" that the U.S. Constitution does not confer a right to abortion. While the ban was in place, multiple children fled the state seeking abortions after being raped. One such case involved a ten-year-old girl from Columbus, Ohio, who traveled to Indiana (where abortion was legal at the time) for the procedure, generating national attention and becoming a central campaign issue. A state court put the ban on hold while a challenge alleging it violated the Ohio Constitution was heard. Several members of the "no" campaign had called for bans on forms of birth control that prevent the implantation of a fertilized egg and in vitro fertilization if the initiative failed.
The "yes" campaign drew support from Ohio medical organizations, doctors, economists, trade unions, editorial boards, reproductive rights groups, and several religious organizations. They argued that a "yes" vote would further limited government, protect bodily autonomy and religious liberty, while preventing interference with patient-physician privacy. The American College of Obstetricians and Gynecology, alongside other professional associations of doctors, campaigned in favor of Issue 1. In August 2023, former President Donald Trump, who appointed three of the Supreme Court justices who voted to overturn "Roe v. Wade", condemned six-week abortion bans, including Ohio's, as going "too far" and a "terrible mistake". Religious groups were generally divided on the issue.
Ohio's Issue 1 was the first time since the "Dobbs" decision that voters of a red state were asked whether to enshrine abortion protections in their state constitution. As such, the referendum's approval was widely interpreted as evidence for a national consensus in favor of broad abortion rights. Among those between 18 and 24 years old, an estimated 76% voted "yes" on Issue 1. Some conservative political analysts and commentators called a continued alliance with the anti-abortion movement "untenable" and an "electoral disaster", and urged the party to adopt a more pro-choice stance on the issue. Exit polling indicated that 61% of Ohioans agree that abortion should be legal in most or all cases, versus 37% who disagree.
Text.
Be it Resolved by the People of the State of Ohio that Article I of the Ohio Constitution is amended to add the following Section:
"Article I, Section 22. The Right to Reproductive Freedom with Protections for Health and Safety"
A. Every individual has a right to make and carry out one's own reproductive decisions, including but not limited to decisions on:
B. The State shall not, directly or indirectly, burden, penalize, prohibit, interfere with, or discriminate against either:
unless the State demonstrates that it is using the least restrictive means to advance the individual's health in accordance with widely accepted and evidence-based standards of care.
However, abortion may be prohibited after fetal viability. But in no case may such an abortion be prohibited if in the professional judgment of the pregnant patient's treating physician it is necessary to protect the pregnant patient's life or health.
C. As used in this Section:
D. This Section is self-executing.
Background.
Heartbeat bill.
In April 2019, the Ohio legislature passed and Governor Mike DeWine signed a "heartbeat bill" that banned abortion after a fetal heartbeat can be detected, which usually occurs about six weeks after conception, before many know they are pregnant. The bill allowed exceptions for threats to the mother's life, but not for rape or incest. The statute was blocked by a federal judge in July 2019, a week before going into effect. It first became active three years later in July 2022, hours after the Supreme Court of the United States issued its decision in "Dobbs v. Jackson Women's Health Organization". The Supreme Court ruled that the U.S. Constitution does not confer a right to abortion, overturning "Roe v. Wade" and allowing states to impose unlimited restrictions on abortion access. The statute was in effect for 82 days before a state court blocked it temporarily in September 2022, and ultimately blocked it indefinitely.
2022 Ohio child-rape and Indiana abortion case.
While the six-week abortion ban was in place, multiple children fled the state for abortions after being raped. The most notable case involved a ten-year-old girl from Columbus, Ohio, who traveled to Indiana on June 30, 2022, to get an abortion. Her case drew national attention and commentary from public figures, due in part to its proximity to the June 24, 2022, decision of the Supreme Court of the United States in "Dobbs".
Her rapist was arrested by July 13. Before this arrest was made public, Ohio politicians who oppose legal abortion access called the story a hoax; Ohio Attorney General Dave Yost said, "Every day that goes by, the more likely that this is a fabrication." After news of the arrest validated the "Star"'s story, these sources did not apologize for claiming the story was a hoax. Jim Bopp, the general counsel for the National Right to Life Committee, said in an interview that the child should have been legally forced to carry the pregnancy to full term and give birth, and that "She would have had the baby, and as many women who have had babies as a result of rape, we would hope that she would understand the reason and ultimately the benefit of having the child." In September 2022, shortly after Ohio's six-week abortion ban went into effect, a woman made national news when she almost bled to death after an Ohio hospital refused to treat her miscarriage.
National context.
Since "Roe v. Wade" was overturned in 2022, voters supported the "pro-choice" side in state referendums along overwhelming and bipartisan margins. In November 2022, Ohio's neighbor Michigan held a similar referendum, called Proposal 3, which passed 57%–43%. While Michigan is considered a swing state, Ohio is socially conservative: Donald Trump won the state by 8% over Joe Biden in the 2020 presidential election. In other red states, voters rejected measures intending to restrict abortion, such as in the 2022 Kansas abortion referendum and 2022 Kentucky Amendment 2. Because Ohio's Issue 1 asked voters whether to explicitly protect abortion, it was widely expected to be a bellwether for the national opinion on abortion rights.
Ballot measure submission.
On February 21, 2023, Ohioans for Reproductive Freedom, the group leading support for the initiative, filed the amendment's language with the office of Ohio Attorney General, Dave Yost, who certified it on March 2. The proposed amendment was then sent to the Ohio Ballot Board, which further certified it on March 13, permitting supporters to begin collecting signatures. On July 5, supporters filed 709,786 signatures, nearly 300,000 more than the minimum number required. The Ohio Secretary of State, Frank LaRose, certified the petition on July 25, 2023, after certifying 495,938 valid signatures, more than the approximately 410,000 required.
Attempt to change threshold.
The Ohio Republican Party tried to increase the threshold required for referendum passage to 60%, in an attempt to thwart the proposed constitutional amendment. The threshold change was put to public vote in an August 8 special election, known as August 2023 Ohio Issue 1. Voters rejected the change 57%–43%, keeping the threshold for passage at a simple majority. It was defeated by a nearly identical margin to November 2023 Ohio Issue 1 passing three months later.
Rejected ballot challenge.
On August 11, 2023, the Ohio Supreme Court unanimously rejected a lawsuit – filed by Republican former state Representative Tom Brinkman and 2022 Republican state representative candidate Jenn Giroux – that would keep the initiative off the ballot.
Campaign.
The campaign for the initiative drew support from Ohio scientific and medical communities, economists, trade unions, editorial boards, human rights, and many religious organizations. They argued that the initiative would limit government, protect bodily autonomy and religious liberty, and prevent interference with personal medical decisions, including another situation similar to the aforementioned abortion case. The American College of Obstetricians and Gynecologists, alongside other professional associations of physicians, campaigned for the citizen-initiated constitutional amendment. According to legal historian Mary Ziegler, "The main force behind the ballot initiative was physicians who said, 'We are not willing to practice medicine under this regime, and we think voters support us.'"
While several Ohio's Catholic dioceses condemned the measure, many Catholic voters were expected to vote for "yes", along with several dissenting groups, including Catholics for Choice.
Controversies.
Comments by ORTL activist Lizzie Marbach.
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The use of birth control, IVF, &amp; other unnatural means of "family planning" has brainwashed us into believing that WE are the authors of when life begins.
This belief has caused so much evil and ultimately led to the death of over 60 million babies due to abortion.
 
 September 11, 2023
Shortly before the election, there was a major rift within the Ohio Right to Life (ORTL) organization. The campaign suffered from intense infighting after comments made by Lizzie Marbach, the organization's communications director. Marbach called for restrictions or bans on birth control and in vitro fertilization, after which she was fired in mid-August 2023.
Marbach also described an image of the Virgin Mary in a Mexican Catholic church as "idolatry". Several Catholic anti-abortion activists urged opponents of the measure to not cast a ballot, or, cast one intentionally spoiled as a protest vote in the wake of the controversy, stating that the "against" campaign was furthering anti-Catholicism.
Ballot wording.
Proponents of the amendment initially suggested that the amendment appear in full on voters' ballots in November. However, the Ohio Ballot Board substituted its own summary wording to appear before voters. The summary, written by Ohio Secretary of State and Republican Senate candidate Frank LaRose and approved by the Ballot Board's Republican majority, received criticism for its allegedly biased language, including opting for the phrase "unborn child" over the medically accurate term "fetus" and omitting reference to other rights the proposed amendment would protect, including contraception, miscarriage care, and fertility treatment. Abortion rights groups sued to have the full text of the amendment presented on the ballot, but the Republican majority on the Ohio Supreme Court sided with the Ballot Board, allowing the language to appear in the ballot summary.
The Ballot Board's summary received criticism from medical groups as well as some voices opposed to legal abortion access, who have described it as deliberately deceiving voters to vote "no" under false pretexts. Conservative columnist Jude Russo wrote, "We have failed to persuade the American people. Simply put: Lawyerly tricks (and tricky lawyers) are losers. Asking the commons to cede power voluntarily is a loser." The American College of Obstetricians and Gynecologists stated, "The language used to discuss abortion has a profound impact on how people form their opinions about reproductive health care, and the emotionally charged language that will now be presented to voters is neither clinically nor legally sound."
Misinformation.
The Issue 1 election generated widespread misinformation. Several factors contributed to voter confusion, including back-to-back ballot questions, duplicate naming of ballot measures, reversed position of the ballot measures, controversy over ballot language, misleading terminology, and misinformation campaigns.
Republican lawmakers and anti-abortion groups – particularly American Policy Roundtable, Ohio Right to Life, and the Center for Christian Virtue – disseminated false claims that the amendment would allow unrestricted abortions up to birth and for minors to obtain abortions without parental consent, among other abortion misinformation. These misleading assertions were strategically spread through digital advertisements and offline events, as well as on a blog on the official Ohio Senate website, gaining prominence in search engine results for coming from a government source.
Advertisements from the "no" campaign claimed that the referendum would take away parental rights and force sex reassignment surgery on children. The claims received widespread criticism from legal experts, who described them as baseless and misleading. Constitutional law expert Jonathan Entin wrote:If you drink too much alcohol, if you ingest certain drugs, if you drive too fast – all of those things could have shorter or longer term