One of the marquee Election Day contests next week is in Ohio, when voters will decide whether to enshrine abortion rights in the state constitution.

A victory would continue a winning streak for abortion rights supporters. In the nearly 17 months since the Supreme Court overturned Roe v. Wade, candidates and ballot measures backing abortion rights have won in every election, including in conservative states like Kentucky and Kansas — as well as in an August special election in Ohio that served as a proxy battle ahead of next week’s vote.

At stake is Issue 1, a proposed amendment that would insert language in the state constitution codifying the right “to one’s own reproductive medical treatment, including but not limited to abortion” and barring the state from “burdening, penalizing or prohibiting” those rights. The proposed measure specifies that abortion would remain prohibited after fetal viability, but includes exceptions to protect the mother’s life or health.

Groups on both sides of the issue have blanketed the airwaves with ads and flooded mailboxes with flyers, but public polling and ad spending data — in addition to national headwinds — favor groups working to pass the measure.

Since Aug. 9, the day after the special election, groups supporting the November Issue 1 measure have spent $18.3 million, compared with $7 million spent by the anti-abortion groups against it, according to AdImpact, a firm that tracks political ad spending. Public polling from July showed that 58% of registered Ohio voters supported enshrining abortion rights in the state constitution.

But reproductive rights groups working to pass the measure next Tuesday say there are warning signs.

“Don’t get too confident here,” said Katie Paris, a progressive activist from the Cleveland area who leads Red Wine and Blue, a national organization that targets suburban women in swing areas.

For one, Paris and others are concerned that voters who support abortion rights may face confusion in casting their ballots, because of the unusual fact that, in the special election just three months ago, Ohioans supporting reproductive rights were casting a ballot against a measure also called Issue 1.

“The whole calling it Issue 1 again has been a bigger problem than I thought it would be,” Paris said. “Is there a status quo bias that leads people just to vote no? There’s just a lot of unknowns here.”

That August ballot measure would have made it more difficult to pass future state constitutional amendments, including the proposed amendment on the ballot Tuesday. Its resounding defeat was a clear win for reproductive rights advocates in Ohio.

Meanwhile, groups working to defeat Issue 1 have in recent weeks rolled out ads featuring conservative heavy-hitters like Tucker Carlson and Ohio Gov. Mike DeWine — who, in particular, abortion opponents feel holds credibility with voters.

“Whether you agree with his previous policies or not, he’s a truth teller,” said Mehek Cooke, a Republican strategist and spokesperson for Protect Women Ohio, the largest spender among groups opposed to Issue 1.

DeWine, whose anti-abortion views have been well-documented since his early days in politics, made himself scarce during the summer special election, apparently sensing that the anti-abortion side was headed for a decisive defeat. 

But the governor, who was re-elected last year by 25 percentage points, also has crossover appeal; his early follow-the-science approach to the pandemic won him admirers among independents and Democrats while alienating him from the far-right flank of his party. In addition to his inclusion in the ads, he has led canvassing events, including one on Monday in Columbus.

Protect Women Ohio, however, has also run ads — both in the lead-up to the August race and now — that opponents, as well as nonpartisan experts, say are designed to mislead voters.

One Spanish-language spot that went up last week inaccurately claimed that passage of Issue 1 would result in abortion “without limits” and “without conditions.” Other ads argued that the measure would restrict parental rights. (Even if Issue 1 passes, abortion would remain illegal after about the 24th week of pregnancy, except when a mother’s health or life was at risk).

Issue 1 critics have also played into transphobia, emphasizing that the proposed amendment includes gender-neutral language — “individual” instead of “woman,” for example — but no age restrictions. The messaging, which nonpartisan experts found misleading, was also used over the summer to urge support for the failed August ballot measure.

Those experts note that there is no mention of transgender rights or parental rights in the amendment and say there is virtually no way the language could be legally interpreted to apply to most topics not specifically mentioned in the measure itself — even when the “not limited to” phrase is considered. In addition, many point out that the amendment mentions nothing about Ohio’s law requiring parental consent for minors seeking abortion care and is likely to have little bearing on it.

Opponents claim that the language in Issue 1 is broad enough that, if the measure were to pass, courts could then have the leeway to circumvent that requirement.

Ohioans United for Reproductive Rights spokesperson Gabe Mann said that such claims were a product of “politicians and extremist groups failing to convince the American public about their view of abortion.”

“All they have is misdirection and lies,” Mann said in a statement. “We’re ready to settle this issue for once and all.”

Nevertheless, Cooke, of Protect Women Ohio, said that the connection to parental rights has resonated with voters.

“When you state to a voter — and I’ve seen this even in my surrounding neighborhoods — that this issue is more than abortion, that it goes further than Roe v. Wade … that it also eviscerates parental rights, the door swings open,” she said, referring to experiences she’s had with her group’s door-knocking efforts.

Passage of Issue 1 would effectively counteract Ohio’s “heartbeat bill,” which snapped into place immediately after the Supreme Court’s Dobbs decision ended the constitutional right to abortion. That state law bans most abortions — with exceptions for the health of the pregnant woman and in cases of ectopic pregnancies — but remains temporarily blocked by a state judge. 

That case is now before the state Supreme Court, which heard oral arguments in September. If Issue 1 passes, it would nullify a prospective ruling allowing the law to stand. If the measure loses and the court lets the law stand, most abortions would be illegal in Ohio around six weeks of pregnancy. 

Another source of concern for Democrats and pro-abortion rights groups has been the approaches taken toward the measure by two major newspapers in the state.

The Toledo Blade, which serves one of the few reliably Democratic urban counties in the state, “has always supported women’s right to an abortion,” its editorial board wrote last week, before urging a no vote: “This amendment to the state constitution goes too far and should be defeated.”

In addition, the editorial board at The Plain Dealer and cleveland.com, which launched an aggressive campaign against the August measure, refused to take a side, infuriating local Democrats.

“Countless media organizations like cleveland.com have fallen into the trap of ‘both sidesism,’ twisting themselves into knots to find something good about the idea of politicians inserting themselves between patients and their physicians,” Cuyahoga County Democratic Party Chair David Brock and Vice Chair Juanita Brent, a state representative, wrote in an open letter last week.

So far, aside from a tweet of support earlier this month from former President Barack Obama, national Democrats have mostly stayed out of the campaign. Mann, of Ohioans United for Reproductive Rights, said there were no plans for President Joe Biden or Vice President Kamala Harris to get involved, nor were any plans being made for any federal office-holders outside of Ohio — Democratic Reps. Marcy Kaptur and Emilia Sykes and Democratic Sen. Sherrod Brown have campaigned for Issue 1 — to become active.

Mann said bringing in national politicians would run counter to the message of the group — and of others supporting Issue 1: that the point of deciding the issue on a ballot measure was to take the decision away from politicians.

On the Republican side, Sen. J.D. Vance spoke at an Ohio March for Life rally this month, while the three most prominent Republicans running for the party’s Senate nomination to challenge Brown have also taken a hands-on approach, including Secretary of State Frank LaRose, whose comments that the August measure was “100% about keeping a radical pro-abortion amendment out of our constitution” became a prominent feature of reproductive rights groups’ ads ahead of that vote.

National groups on both sides have closely been involved, too. 

Marjorie Dannenfelser, the president of the Susan B. Anthony Pro-Life America, hosted a canvassing event on Monday, while Planned Parenthood Action Fund President Alexis McGill Johnson hosted one in Cincinnati on Friday.

Meanwhile, despite her warnings to fellow progressives to not grow complacent because of the polling advantage, Paris, of Red Wine and Blue, remains quietly optimistic.

Her group, which organizes through social media and has more than 30,000 members in the state, has engaged with faith-based organizations that support reproductive rights and has held several events to educate voters about the ballot language.

“We get massive attendance,” she said.