COLUMBUS, Ohio (AP) – Ohio voters approved a constitutional amendment on Tuesday that ensures access to abortion and other forms of reproductive health care, the latest victory for abortion rights supporters since the U.S. Supreme Court overturned Roe v. Wade last year.

Ohio became the seventh state where voters decided to protect abortion access after the landmark ruling and was the only state to consider a statewide abortion rights question this year.

The outcome of the intense, off-year election could be a bellwether for 2024, when Democrats hope the issue will energize their voters and help President Joe Biden keep the White House. Voters in Arizona, Missouri and elsewhere are expected to vote on similar protections next year.

Ohio’s constitutional amendment, on the ballot as Issue 1, included some of the most protective language for abortion access of any statewide ballot initiative since the Supreme Court’s ruling. Opponents had argued that the amendment would threaten parental rights, allow unrestricted gender surgeries for minors and revive “partial birth” abortions, which are federally banned.

Public polling shows about two-thirds of Americans say abortion should generally be legal in the earliest stages of pregnancy, a sentiment that has been underscored in both Democratic and deeply Republican states since the justices overturned Roe in June 2022.

Before the Ohio vote, statewide initiatives in California, Kansas, Kentucky, Michigan, Montana and Vermont had either affirmed abortion access or turned back attempts to undermine the right.

Voter turnout for Ohio’s constitutional amendment, including early voting, was robust for an off-year election. Issue 1’s approval will all but certainly undo a 2019 state law passed by Republicans that bans most abortions after fetal cardiac activity is detected, with no exceptions for rape and incest. That law, currently on hold because of court challenges, is one of roughly two dozen restrictions on abortion the Ohio Legislature has passed in recent years.

Issue 1 specifically declared an individual’s right to “make and carry out one’s own reproductive decisions,” including birth control, fertility treatments, miscarriage and abortion.

It allowed the state to regulate the procedure after fetal viability, as long as exceptions were provided for cases in which a doctor determined the “life or health” of the woman was at risk. Viability was defined as the point when the fetus had “a significant likelihood of survival” outside the womb, with reasonable interventions.

Anti-abortion groups, with the help of Republican Gov. Mike DeWine, tested a variety of messages to try to defeat the amendment, primarily focusing on the idea that the proposal was too extreme for the state. The supporters’ campaign centered on a message of keeping government out of families’ private affairs.

The latest vote followed an August special election called by the Republican-controlled Legislature that was aimed at making future constitutional changes harder to pass by increasing the threshold from a simple majority vote to 60%. That proposal was aimed in part at undermining the abortion-rights measure decided Tuesday.

Voters overwhelmingly defeated that special election question, setting the stage for the high-stakes fall abortion campaign.