BOISE, ID – While there will be far fewer ballot initiatives affecting abortion access in the 2026 midterm elections than there were in the previous national election, two in Republican-led states could be consequential.

About 51% of Missouri voters approved an amendment to the state constitution in November 2024 that added a right to reproductive health care, including abortion up to fetal viability, overturning the state’s near-total abortion ban. In the year since, access has largely not been restored, and Republican lawmakers sent another amendment to the 2026 ballot that would undo the new protections. If approved by voters, the measure would reinstate the abortion ban with few exceptions and also ban gender-affirming care for minors.

There are now several court cases about other laws on the books making access nearly impossible to restore. There have also been legal battles over misleading and inaccurate language in the ballot question. In early December, an appeals court reworded it, because the judges determined the original version did not sufficiently inform voters that a “yes” vote would mean repealing the right to an abortion.

“With bills filed already threatening prosecution against providers and patients, it is crucial that Missourians know they are being asked to end the protections for reproductive health care that we just passed in the last general election,” Tori Schafer, director of policy and campaigns for the ACLU of Missouri, said in a statement.

The back-and-forth has created a fractured reproductive health care network in Missouri, where abortion care is inconsistently available, forcing most people to continue traveling out of state for care. Similar scenarios could transpire in Idaho if voters approve a citizen-drafted law restoring access to abortion and protecting reproductive health care procedures like IVF. Idaho also has a Republican supermajority legislature, and an attorney general who has repeatedly expressed a commitment to keeping Idaho’s near-total abortion ban intact, even as doctors leave the state and care vanishes from rural areas.

Idahoans United for Women and Families has been leading the initiative and gathering signatures for months. The group said in late November that it had collected more than 50,000 signatures of the 71,000 needed by the end of April to make the ballot.

“There is no allowance in Idaho’s current law for the health of the mother, for the future fertility of the mother, for a fatal fetal diagnosis that is incompatible with life,” said lead organizer Melanie Folwell in a statement. “None of that is covered in Idaho’s extreme ban. And that’s why we need to fix it.”

Idaho has been at the center of a debate over whether states with bans are required to perform an abortion under the Emergency Medical Treatment and Labor Act , or EMTALA, a federal law mandating stabilizing treatment for patients who come to the emergency room of most hospitals. At one point, while that subject was debated, Idaho’s largest hospital airlifted six patients to nearby states because the legality of terminating a pregnancy in an emergency was uncertain. A new lawsuit between that hospital system and the state attorney general’s office is still underway.

Since Idaho does not allow citizens to amend the state constitution, Idaho legislators could easily repeal the law, though organizers have said they plan to continue the fight and run another referendum if that happens.

Nevada, Virginia questions would reaffirm existing rights

Nevada voters will be asked to vote again on a right to abortion initiative that passed overwhelmingly in 2024, because state law requires a constitutional amendment to appear on the ballot twice in even-numbered election years before it can take effect. Abortion is legal in Nevada up to 24 weeks, with exceptions after that point to preserve the pregnant person’s health or life. More than 64% of Nevada voters approved the ballot question in 2024.

In Virginia in 2025, the legislature referred a constitutional amendment question to voters establishing the right to reproductive freedom, but the newly elected delegation will need to reaffirm that intention in the upcoming legislative session for it to appear on the 2026 ballot. Since Democrats hold a majority in the Virginia House of Delegates, it is expected to move forward.

The midterm elections will take place Nov. 3 nationwide.

Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: info@idahocapitalsun.com.