Election laws, abortion access, healthcare for transgender youth and a requirement for sex verification for children are on state ballots in November.

Voters across the country will be voting on how elections are administered, access to reproductive healthcare and one measure to require students to undergo sex verification examinations to participate in sports as early as elementary school. File Photo by Bonnie Cash/UPI UPI Protesters in favor of transgender athletes competing in women's sports gather outside the Supreme Court in Washington, D.C., on Jan.13. Colorado, Arizona and Washington have ballot measures that would restrict the eligibility of transgender athletes in school-based sports activities. File Photo by Bonnie Cash/UPI UPI Pro- and anti-abortion supporters exchange words outside of Planned Parenthood, hours after the Supreme Court's decision overturning the 1973 Roe vs. Wade ruling, in St. Louis on June 24, 2022. In November, voters in Missouri will vote on a measure attempting to repeal the constitutional right to an abortion. Voters approved the constitutional right to an abortion in 2024. File Photo by Bill Greenblatt/UPI UPI

Aug. 31 (UPI) -- Voters across the country will be voting on how elections are administered, access to reproductive healthcare and one measure to require students to undergo sex verification examinations to participate in sports as early as elementary school.

There are more than 150 ballot measures certified to move ahead in at least 40 states on Nov. 3. More initiatives are pending with deadlines drawing near.

Among the big topic areas that are recurring across several states are abortion policies, citizenship and voter identification requirements and sex-based eligibility to participate on school sports teams.

These are just some of the ballot initiatives that will be decided by the states in the midterm elections.

Abortion policy

Abortion policies have been dominant topics in each election cycle since the U.S. Supreme Court overturned the landmark Roe vs. Wade decision in 2022. The Dobbs decision overturned decades of precedent and posed to the states the question of how each would approach access to abortion services.

Since the Dobbs decision, 17 states have voted on measures related to abortion. Ten states voted on initiatives to affirm access to abortion as a constitutional right. Those initiatives succeeded in seven states: Arizona, Colorado, Maryland, Missouri, Montana, Nevada and New York.

Florida, Nebraska and South Dakota voted down measures to establish abortion protections in their state constitutions.

In November, four states will send voters to the polls to decide the future of abortion access within their borders.

Nevada and Virginia have placed constitutional amendments on the ballot to establish the right to an abortion. Question 6 in Nevada and Question 1 in Virginia have slightly different language but effectively enshrine access to an abortion as a constitutional right.

Question 6 was on the ballot in 2025, with 64% of voters voting in favor. Nevada requires that a constitutional amendment be affirmed in consecutive elections to be adopted.

A "yes" vote in Nevada would enshrine the right to an abortion before fetal viability. Abortion services may be provided after fetal viability if it is necessary to protect the patient's life or health.

Under current law, abortion is allowed up to 24 weeks of pregnancy in Nevada.

A "yes" vote in Virginia would establish "the right to make and effectuate one's own decisions about all matters related to one's pregnancy." This right could not be infringed upon unless there is a compelling state interest.

The state would maintain the right to regulate abortion in the third trimester of pregnancy but abortion could not be prohibited if the fetus is not viable or if an abortion is deemed necessary by a doctor to protect the life, mental and physical health of the patient.

Current Virginia law does not "explicitly provide to its citizens a right to reproductive freedom nor does it explicitly protect or prohibit certain kinds of health care procedures or decisions," the Virginia Department of Elections says.

Idaho has a citizen-initiated measure on the ballot that would establish the right to an abortion by statutory amendment. The language of Proposition 1, as proposed by state election officials, is currently under challenge as proponents of the measure say the state's wording is misleading and shows bias.

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The nonprofit organization Idahoans United for Women and Families, the group that campaigned to put the question on the ballot, has filed a lawsuit challenging Idaho Attorney General Raul Labrador and Secretary of State Phil McGrane over the wording.

The organization said in a press release that Idaho ballot measures usually have short summaries of similar length next to the "yes" and "no" voting bubbles. These summaries average about 11 words.

The "no" language on Proposition 1 is lengthier and is where the lawsuit alleges state officials are showing bias. The "no" summary reads: "A NO vote would make no change to Idaho's current law, which protects the life of the unborn while allowing abortion in reported cases of rape or incest, or when necessary to protect the life of the mother."

The lawsuit by Idahoans United for Women and Families is the second against election officials over ballot language. Last year, the state supreme court ruled that ballot language was misleading and ordered that it be rewritten.

Missouri is holding a vote over a measure attempting to repeal the constitutional right to an abortion. Voters approved the constitutional right to an abortion in 2024. Amendment 3, if passed, would also prohibit gender-affirming health care transgender youth.

A "yes" vote on the Prohibit Abortion and Gender Transition Procedures for Minors Amendment would prohibit abortion services unless there is a "medical emergency, fetal anomaly, rape, or incest." Abortions in the cases of rape or incest would only be allowed within the first 12 weeks of gestation.

The ban on health care for transgender youth would prohibit surgical procedures and hormone and puberty-blocking drugs for minors.

The 2024 amendment to establish the right to an abortion passed with about 51% of the vote in favor. More than 1.5 million people voted in favor of the amendment.

Citizenship and voter ID requirements

Six states will weigh in on measures to require voters to be citizens of the United States to vote in any elections.

Non-citizens are already restricted from voting in federal elections. Some municipalities allow non-citizens to vote in local elections, such as school board elections. This is determined by the laws of each individual state.

Alaska, Arkansas, Kansas, South Dakota and West Virginia's ballot initiatives seek to define who is eligible and ineligible to vote in any election based on their citizenship status. Alaska's ballot measure is a citizen-initiated statute while the other states' ballot questions pose amendments to their state constitutions.

A "yes" vote in these measures would establish that "Only a person who is a citizen of the United States" is eligible to vote in any election, with language varying among the states.

The status of non-citizen voting is slightly different in Arizona, where a constitutional amendment would allow for "only citizens" to vote in Arizona elections. The state's constitution already limits voting to U.S. citizens.

Arizona's Proposition 144 also establishes voter identification requirements. A vote in favor of the measure would expressly prohibit "foreign nationals" from making "contributions" to elections and states that "no person may knowingly accept such a contribution."

"Foreign nationals may not contribute or expend money or anything of value to influence an Arizona election," the ballot measure says.

California, Colorado, Nevada, North Carolina, Ohio and Oklahoma also have measures related to voter identification on the ballot. This makes 2026 the year with the most measures on ballots related to voter identification in a single year.

A vote "yes" on California's Proposition 39 would require any person who wishes to cast a ballot to present a form of government-issued identification or provide the last four digits of such an ID when voting in person or registering for a mail-in ballot.

Proposition 39 also places requirements on election officials to maintain voter rolls with citizenship verification and adds additional compliance requirements.

The language before other states are similar in nature. For example, North Carolina's Require Voter Identification Amendment would amend its constitution to require a photo ID for all voters, regardless of their method of casting a ballot. State Question 846 in Oklahoma would also establish in its state constitution that voters must show proof of identity to vote.

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Current law in Oklahoma requires voters to show proof of identity when voting in person or to have their ballot notarized when voting by mail.

Health care for transgender youth and sports eligibility

Two ballot measures will ask voters to determine the rights of transgender youth to receive certain medical treatments.

The Colorado Prohibit Surgeries for Treatment in Response to Minors' Perception of Sex or Gender Measure asks voters to weigh in on whether healthcare professionals should be prohibited from providing treatments, including surgeries, that "alter" "biological sex characteristics" of minors based on the minor's "perception of sex or gender."

A "yes" vote on this measure, also known as Proposition 135, would restrict healthcare professionals from providing these treatments under most circumstances. It would also prohibit the use of government funds or health insurance to pay for such treatments.

If passed, the proposition would allow exceptions for male circumcisions and "treatments for medically verifiable disorders of sex development or acquired physical or chemical abnormalities." It does not restrict "social transition options and counseling."

Missouri's proposal is for a constitutional amendment that, if passed, would prohibit "gender transition procedures for minors." It would also repeal the right to access abortion services, which was passed by voters in 2024.

Gender-related treatments that would be prohibited include surgeries, hormone treatments and puberty-blocking drugs.

Colorado is among three states with ballot measures that would restrict the eligibility of transgender athletes in school-based sports activities.

Colorado's Initiative 109, the Colorado Sex Requirement for School and College Sports Initiative, would require that "all elementary through collegiate school-based athletic teams and spots be designated as male-only or female-only based on biological sex, unless the team or sport is designated as open to participation by individuals of any sex or gender."

If passed, the measure would also place requirements on schools and school districts to enforce gender designated sports requirements and prohibit investigations or penalties on any school that designates a team or spot as "female-only."

This measure would apply to all public, charter, private and religious school teams in elementary school through high school, as well as all public and private colleges, universities and community colleges.

Similarly Arizona's Proposition 318 is a bathroom ban that would prohibit schools and athletic associations from allowing transgender athletes to access the bathroom or locker room that matches their gender identity. It would also add a definition of sex as the "biological status as male or female as recorded at birth."

Washington's Initiative IL26-638, the Washington Sex Verification Requirements for Female School Sports Initiative, would require school districts and organizations that regulate school activities to "prohibit biologically male students from competing with and against female students in athletic activities with separate classifications for male and female students."

If passed, this restriction would apply to sports "intended for female students only" in individual and team sports.

Washington's proposal goes further than other similar prohibitions on athletic participation for transgender youth, adding a requirement for students in activities as early as elementary school to undergo sex verification examinations before participating in sports.

"This established requirement provides a reliable and medically verified basis to determine a student's biological sex," the initiative reads. "Leveraging the existing physical examination process to verify biological sex ensures equity, safety, and competitive balance in sports intended exclusively for female students."