Richmond, Virginia: A longside the first US presidential election since the Supreme Court overturned a constitutional right to abortion, voters in 10 states will weigh in directly on whether to protect reproductive rights or, in at least one case, restrict them.
Proponents and opponents of expanding abortion rights are in the midst of a costly, high-stakes campaign to win in the states where abortion rights are also on the ballot.
And the deeply divisive issue could help decide who takes the White House by influencing the outcome in key battleground states like Arizona and Nevada.
Since the Supreme Court overturned the 1973 Roe v. Wade ruling on reproductive rights in June 2022, abortion rights supporters have won all seven times the issue has been put directly to voters in individual states.
"We are hopeful that as voters go to the polls this season, because abortion is so at the front of their minds, they're also considering who will best protect their rights in the legislature," said Olivia Cappello, a spokesperson for Planned Parenthood Action Fund, the political arm of Planned Parenthood, which provides a range of women's healthcare services as well as abortions in states where it is legal.
A majority of Americans disagreed with the Supreme Court's 2022 ruling, which fueled a wave of Democratic wins in that year's midterm elections and left Republicans scrambling to find a winning message on the issue.
While polling shows voter concerns about the economy outweigh reproductive rights, Harris has emphasized the issue much more during her campaigning than President Joe Biden did before he retired from the race.
In the final days before the vote next week, Harris headed to Texas, a conservative state that has among the most stringent abortion restrictions in the country and is a staunch Republican stronghold that she is unlikely to win.
Introduced by singer Beyoncé, Harris spoke about the danger that Trump, and Republicans, could present to abortion rights across the country if he is elected again.
Trump has touted his role in appointing justices to the Supreme Court who voted to overturn Roe v. Wade - but has also appeared wary about how he and Republicans are perceived on the issue and repeatedly says decisions on reproductive rights are now up to individual states.
Following the overturning of Roe v. Wade, abortion has been banned or heavily restricted in more than a dozen US states, leaving millions of women without access to abortion care.
"In this election, I think we are going to see abortion continue to be a peak issue for voters and see a real shift in how people are making decisions about who they put in office," Cappello said.
Ten states
Voters are set to decide on whether to expand or protect abortion access in Florida, Arizona, Nevada, Colorado, Montana, South Dakota, Missouri, New York, Maryland, and Nebraska. In some cases, they will be asked whether state constitutions should be amended to guarantee abortion rights.
There is also a competing measure on the ballot in Nebraska that would affirm the state's ban on abortion after 12 weeks of pregnancy.
"It's not been easy – the movement and the donor universe that we have ... is something we've had to grow," said Caroline Mello Roberson, director of state campaigns for the advocacy group Reproductive Freedom for All.
"And we've done that, actually. But it is a big deal, right, to have 10 ballot initiatives about abortion when we have had so few in the past."
Polling shows that several of these ballot initiatives appear on track to pass, notably in battleground states like Arizona and Nevada.
A Harris campaign official, speaking on condition of anonymity, said they see the high support for pro-choice ballot initiatives as indicators that "we have a lot of room to move people on this issue".
"We don't expect the ballot initiatives to deliver these states for us, but in a close race this is a motivating issue that could bring more people to Harris' side since she is so aggressively campaigning on the importance of reproductive freedom," the official told the Thomson Reuters Foundation.
Unlike in other states, Amendment 4 in Florida, which would protect abortion rights up until fetal viability, requires 60 per cent of the vote instead of a simple majority - making prospects for passage dicier in a state that has trended Republican red over the last decade.
Florida Governor Ron DeSantis has been heavily involved in the "no" campaign, giving anti-abortion activists a powerful ally in the key state.
An October New York Times/Siena College poll found that 46 per cent of likely Florida voters said they would vote yes, 38 per cent would vote no, and 16 per cent were undecided or refused to answer.
"The abortion lobby would like Americans to think passage of abortion amendments (is) inevitable, but the dynamics are different this year with six red states considering ballot measures," said Kelsey Pritchard, state public affairs director with Susan B. Anthony Pro-Life America, an anti-abortion advocacy group.
Trump, who is registered to vote in Florida, turned heads in August when he appeared to express opposition to an abortion ban after six weeks of pregnancy - which is current law in Florida - but he swiftly clarified that he would be voting 'no' on Amendment 4.
Anti-abortion activists say sloganeering by opponents appears to be carrying the day in some cases and voters haven't always understood exactly what they were voting on.
"What we're seeing, too, is that people, because of the lack of understanding as to what is going into the verbiage here, they're hearing reproductive freedom and that their reproductive freedom is on the line," said Andrea Trudden from Heartbeat International, an anti-abortion advocacy group.
"And so they are voting for that, quote, freedom, and not clearly understanding that it's taking away, it's superseding all other laws that are about abortion within the states."
Defining issue?
Democrats rode a wave of anger over the 2022 Supreme Court ruling to a better-than-expected performance in that year's midterm elections – but it's unclear exactly to what extent abortion will be a motivating factor for other races on Nov. 5.
Right behind the economy (28 per cent), likely voters named abortion as the second-most important issue (14 per cent) in deciding their vote, according to a New York Times/Siena College poll released in October. Immigration, a subject Trump has prioritized, was third at 12 per cent.
Cappello of Planned Parenthood Action Fund said it remained to be seen whether the ballot measures themselves will actually shift voting patterns, but that abortion-related measures work across partisan lines.
"When voters have an opportunity to decide directly on issues of reproductive freedom, they will decide in favor of protecting their rights and protecting access to abortion for future generations," she said.
Mello Roberson said the initiatives themselves do not divide people along what observers might expect to be typical party or partisan lines.
"The southwest is full of people who like to not be a joiner, so there's a lot of nonpartisan voters in this part of the country," said Mello Roberson, who counts Nevada as her home state.
"And so these ballot campaigns are really powerful for not feeling so polarizing. This is an issue that they care about."