Before Ohio voters amended their constitution last year to protect abortion rights, the state's attorney general, an anti-abortion Republican, said that doing so would upend at least 10 state laws limiting abortions. But those laws remain a hurdle and straightforward access to abortions has yet to resume, said Bethany Lewis, executive director of the Preterm abortion clinic in Cleveland. "Legally, what actually happened in practice was not much," she said.

Today, most of those laws limiting abortions — including a 24-hour waiting period and a 20-week abortion ban — continue to govern Ohio health providers, despite the constitutional amendment's passage with nearly 57% of the vote. For abortion rights advocates, it's going to take time and money to challenge the laws in the courts. Voters in as many as 13 states could also weigh in this year on abortion ballot initiatives.

But the seven states that have voted on abortion-related ballot measures since the Supreme Court overturned federal abortion protections two years ago in Dobbs v. Jackson Women's Health Organization show that an election can be just the beginning. The state-by-state patchwork of constitutional amendments, laws, and regulations that determine where and how abortions are available across the country could take years to crystallize as old rules are reconciled with new ones in legislatures and courtrooms.

And even though a ballot measure result may seem clear-cut, the residual web of older laws often still n.