Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily.

In both red states and blue ones, abortion opponents have been on a terrible losing streak on ballot initiatives in the four years since Roe v. Wade was overturned. This coming November, though, they may have finally found a way to change their luck: by confusing voters about what exactly they’re voting for.

Since the 2022 Dobbs ruling, the anti-abortion movement has largely failed to stop a barrage of ballot measures on reproductive rights. First, in 2022, voters in Kansas rejected an effort to undo a state Supreme Court decision protecting abortion. There were further setbacks in California, Vermont, New York, Kentucky, Montana, Michigan, and Ohio. Most strikingly, Missouri, a state with some of the nation’s harshest abortion laws, passed a ballot measure protecting reproductive rights, even as voters elected a Republican supermajority to the state Legislature and favored Donald Trump by an 18-point margin.

The few bright spots for abortion foes can’t be all that comforting. In one of the reddest states in the union, South Dakota voters rejected a strange proposal to reinstate something like the antiquated trimester framework from Roe v. Wade. And Nebraska voters enacted a ballot measure that banned later abortions (with exceptions for rape, incest, and medical emergencies), leaving most procedures in the state untouched.

That left the anti-abortion movement without a clear ballot-initiative playbook moving forward. Wins might be possible in the nation’s most conservative states, or in jurisdictions like Florida that require supermajority support before a ballot measure became part of a state constitution. Everywhere else, it wasn’t obvious how abortion opponents could stop the bleeding.

In Missouri, conservatives went to court, insisting that the state’s reproductive rights ballot measure actually allowed for fairly sweeping abortion restrictions. In Ohio, some Republicans even trotted out the independent state legislature theory, best known as a way for election deniers to hand partisans exclusive control over elections, stripping state courts of power to implement new reproductive rights.

There was always the possibility of replicating the Nebraska strategy in Missouri, but that required permitting abortions early in pregnancy, when the vast majority of terminations take place. And that wouldn’t do anything to reverse the constitutional amendments already on the books.

Missouri Republicans may have finally landed on a recipe for success: focusing on transgender Americans. You may wonder what transgender rights have to do with restoring Missouri’s rigid abortion ban. The answer: nothing at all, except in the minds of voters that Republicans seem to have successfully courted.

Like many conservative states, Missouri has banned gender-affirming care for minors since 2023. Missouri also excludes gender-affirming procedures for anyone of any age from the state’s Medicaid program.

But panic about transgender rights has been politically powerful, and Missouri Republicans know it. Last year, the Legislature created a new ballot measure that would undo the one that voters just chose to make law. The ballot measure appeals to popular positions: emphasizing that it would make abortion legal in cases of rape or incest, for example, without stressing the aim of the proposal: to criminalize every other abortion in the state. The measure also stresses that it would prohibit gender-affirming care for minors. And like the measure that Missouri voters just passed, this one would also be called Amendment 3.

A fight about how the measure is framed has unfolded in Missouri courts, with reproductive rights supporters asking courts to force the state to disclose the impact the amendment would have on abortion access. In December, an appellate court forced Republicans to clarify it would repeal the 2024 Right to Reproductive Freedom Amendment.

But recent polling by St. Louis University and YouGov suggest that focusing on gender-affirming medicine for minors may be even more important. Missouri voters support banning gender-affirming care by overwhelming margins—never mind that state law already has done so. The poll revealed that voters were willing to support the Republican proposal, Amendment 3, by a margin of 47 to 40 percent. That suggests that Republicans may be able to ban virtually all abortion simply by attaching it to symbolic initiatives targeting transgender teenagers.

That’s not an entirely new idea. Abortion opponents in Congress, in red states, and in interest groups have been pressing the Trump administration for new restrictions on mifepristone, a drug used in more than half of all abortions. Trump hasn’t just ignored these requests; the administration has actually approved a new generic form of mifepristone and asked courts to dismiss lawsuits intended to place limits on mifepristone.

The Supreme Court Just Heeded One of Ketanji Brown Jackson’s Sharpest Dissents

To placate social conservatives, Trump has offered anti-trans measures as an alternative. Republican presidents have long enforced the Mexico City Policy, which prohibits international aid groups that receive U.S. funding from providing abortion services or counseling (even with other funding). To mark the annual March for Life, Trump announced that the Mexico City Policy would now also prohibit Diversity, Equity, and Inclusion and “gender ideology,” clearly a catchall term for ideas and services for transgender people. Trump has rolled out any number of related policies, and sprinkles interviews on a wide range of topics with warnings that his opponents pursue “transgender for everyone.” The plan is clear: Americans who want an abortion ban might just be satisfied if the president does and says enough to condemn “gender ideology.”

Popular in News & Politics

This Content is Available for Slate Plus members only The Supreme Court Just Heeded One of Ketanji Brown Jackson’s Sharpest Dissents

Sam Alito’s Latest Reversal at the Supreme Court Is an Absolute Embarrassment

Reporters Keep Calling Trump’s Cell. The Answers He’s Giving Them Are Revealing One Core Truth.

That strategy doesn’t seem to have convinced anti-abortion Americans, who, after all, have been mobilized for more than a half century—and see their cause as the human rights fight of our generation. But Missouri Republicans have reason to think that focusing on transgender issues may work as a way to ban abortion.

It’s not clear what will actually happen in Missouri on Election Day. After all, passing Missouri’s new Amendment 3 wouldn’t actually change anything about gender-affirming care for minors, but it would have major effects on abortion. The measure allows abortion in cases of medical emergency and fetal anomalies, but doesn’t clearly define either one. We’ve already seen in other states how physicians are afraid to rely on this kind of ambiguous language, even when a patient’s life or health is on the line. And it would write all of this into the state constitution, which could be changed only with another ballot measure like the last one.

Educating voters about what exactly is on the line will be key to whatever happens next with Amendment 3. But unless something changes, the Missouri experience suggests that Republicans will try to use their success against transgender rights to destroy reproductive liberty too.

Get the best of news and politics

© Slate