When the US Supreme Court overturned Roe v. Wade in June 2022, it ended the constitutional right to have an abortion and returned the ability to regulate the procedure to the states. Now, amid a heated presidential election that resulted in a win for Donald Trump, a handful of states have voted to enshrine reproductive rights into their state constitutions.

On Tuesday, Americans in 10 states voted on ballot initiatives to protect or expand abortion access. Seven of those states successfully passed protective measures, underscoring the widespread unpopularity of restrictive abortion policies.

Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York passed referendums upholding abortion rights, while measures to restore or expand access failed in Florida, Nebraska, and South Dakota. Abortion is already legal until viability in Maryland, Montana, and New York, and throughout pregnancy in Colorado with no restrictions, so the passage of these measures will not change access to abortion in those states.

Nevada currently allows abortions through 24 weeks, but the ballot initiative passed on Tuesday would extend that until fetal viability. Voters will have to approve the measure again in 2026 in order to formally amend the state’s constitution.

Arizona and Missouri were two of the many states that moved to restrict abortion access after the repeal of Roe v. Wade. Arizona banned abortion after 15 weeks of gestation, but that law will now be unconstitutional under the newly passed amendment. In Missouri, a trigger law banned abortions at all points of pregnancy, except to save the life of the pregnant person. The law, one of the strictest abortion bans in the county, made no exceptions for rape or incest. But on Tuesday, voters backed an amendment that would end that ban and amend the Missouri constitution to protect abortion access.

In Florida, an amendment that would have prohibited laws restricting abortion gained 57 percent of the vote, falling short of the 60 percent threshold it needed to pass. The state currently bans abortion at six weeks of pregnancy, and enforces other abortion restrictions.

Meanwhile, Nebraska voters weighed competing ballot measures on abortion rights, ultimately passing one that upholds an abortion ban after the 12th week of pregnancy. Voters in South Dakota rejected a proposal to protect abortion rights, preserving a near-total ban there.

After President Joe Biden dropped out of the presidential race in July, reproductive rights organizations were quick to throw their support behind Vice President Kamala Harris, who made abortion rights a major part of her presidential campaign.

Polls have found that most Americans favor abortion being legal to some degree. In one poll, conducted by Pew Research in April, 63 percent of Americans said abortion should be legal in all or most cases.

Trump has not endorsed a national abortion ban, but has said that abortion is an issue that should be left up to states to decide. In his first term, his Supreme Court appointees Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett set the stage for the overturning of Roe v. Wade in 2022. The three justices were among the five who made up the majority opinion to repeal Roe.

State abortion bans enacted since then have meant that in many parts of the South and Midwest, patients must cross multiple state lines to get an abortion. In recent months, there have been a handful of reports of women dying after facing delays in accessing abortions or miscarriage care because of restrictive state policies.

A second Trump administration could make it even harder for women to access abortion—even in states that have adopted protections—if it decides to enforce a “zombie law” from 1873 called the Comstock Act, which bans the mailing of obscene matter, including abortion-related materials. It could effectively prohibit the mailing of abortion pills, the preferred method of abortion now in the US. Trump has said, “We will be discussing specifics of it, but generally speaking, no, I would not,” when directly asked if he would enforce the act. However, the Heritage Foundation’s Project 2025—a policy playbook for the next Republican administration that Trump has disavowed but to which several of his former officials contributed—calls for using it to stop mail-order abortion pills.

Even if he doesn’t enforce the Comstock Act, Trump could still roll back access to abortion pills in other ways. Under Biden, the Food and Drug Administration removed the in-person dispensing requirement for mifepristone, one of two pills used in a medication abortion, which paved the way for telehealth clinics to offer mail-order abortion drugs. An FDA under Trump could restore that requirement, making it more difficult for women to obtain them.