A few blocks from the Ohio State University campus in Columbus, America’s battle over abortion is playing out under one roof. On one side of a squat single-story office building, a Planned Parenthood clinic offers reproductive health care and refers patients for abortions. Next door is a branch of Pregnancy Decision Health Center, a crisis pregnancy center that offers counseling and support for pregnant women – but also works to dissuade them from terminating their pregnancies and has been accused of promoting misinformation about abortion.

The fate of abortion rights and abortion access will be determined this November at the state and local level during midterm elections. Since the Supreme Court overturned Roe v. Wade in June of this year, most abortions have been banned in 14 states and are actively threatened in seven. Now, voters will directly influence the future of abortion in five states, while local gubernatorial and judicial races across the country will similarly shape the makeup of each state’s abortion access—either acting as stopgaps between the state and abortion bans or paving the way for expanding an already staggering abortion desert.

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.

Earlier this year, five people altered the landscape of reproductive rights in more than a dozen states across the country when the Supreme Court overturned Roe v. Wade. In November, millions of voters will weigh in, casting votes in dozens of races and ballot measures that will determine how restrictive their state can be. Ballot initiatives in three states could determine abortion access for millions of women and what kind of reproductive health care is available to them. Abortion has also become a key issue in races for governor and state attorneys general, who have direct control over their states’ abortion laws and how they are enforced. Democratic candidates for governor want to gain or retain veto power over Republican-controlled state legislatures that want to curb abortion rights.

Allison Case, a family medicine physician, spends much of her time working in a hospital where she delivers babies and provides reproductive health care services, including abortions…In the U.S., more than a dozen states severely restrict access to abortion, and almost as many have such laws in the works. Across the country, since Roe v. Wade was overturned, clinics that do provide abortions have seen an increase in demand. Many clinics rely on help from physicians out of state, like Case, who are able to alleviate some of the pressure and keep wait times down by providing services via telemedicine. But as more states move to restrict abortion, these providers are finding themselves navigating an increasingly complicated legal landscape. Is abortion by telemedicine legal? Experts differ.

Five forthcoming state ballot initiatives on abortion rights could add fissures to the fractured post-Roe landscape and the evolving patchwork of reproductive health policies. The big picture: The U.S. Supreme Court decision overturning the constitutional right to an abortion has hardened sentiments in red and blue states and put critical access questions in front of voters this fall. Kansas showed how potent the issue is in driving turnout last month, when voters during state primary elections overwhelmingly rejected an amendment that would have struck abortion protections in the state’s constitution. The turnout of more than 900,000 was nearly half of all registered voters in the state, and almost double the amount of voters that Kansas normally sees in a primary election.

Thirty Democratic senators led by Washington’s Patty Murray are calling on the Biden administration to use health care privacy laws to protect patients’ reproductive health information, specifically when it comes to abortion. In the letter sent Tuesday, first shared with The 19th, the senators ask the Biden administration to use the Health Insurance Portability and Accountability Act (HIPAA) to prohibit health care providers and personnel from sharing any information about patients’ medical records “without explicit consent.”