Maryland has some of the strongest abortion protections in the country, a longstanding Democratic supermajority in the state legislature, and a governor who proclaimed the state a “safe haven” for the procedure.

Now, voters will decide whether to add yet another safeguard. If Question 1 passes on a simple majority Nov. 5, it would enshrine a right to reproductive freedom in the state constitution.

There’s no immediate threat that Maryland will experience the erosion of abortion rights that other states have seen since the Supreme Court overturned Roe v. Wade in 2022. Proponents acknowledge a constitutional amendment is likely to have minimal day-to-day impact — and some providers say Maryland needs to turn its attention to funding for the procedure, as out-of-state patients increasingly seek care here.

But the fall of Roe taught Maryland abortion activists to take nothing for granted, and at a time when reproductive health issues are on the forefront of voters’ minds, they say they want to seize the opportunity to enact as many safeguards as possible.

“We’ve seen now that 49 years of precedent was not enough,” said Erin Bradley, chair of Freedom in Reproduction Maryland, which is leading the pro-Question 1 effort. “We accepted the protections set forth in Roe, and then they fell pretty quickly, and it was a shock. What we’re seeing is folks, especially folks in blue states, mobilizing to make sure that that can’t happen again.”

Question 1 asks voters to approve or reject a constitutional amendment that reads, in part, “every person, as a central component of an individual’s rights to liberty and equality, has the fundamental right to reproductive freedom, including but not limited to the ability to make and effectuate decisions to prevent, continue, or end one’s own pregnancy.”

Maryland already allows abortion at all stages of pregnancy. It also requires coverage of the procedure by Medicaid and private insurances, shields providers who perform abortions for out-of-state residents, mandates that universities provide reproductive health care, and funds security at abortion clinics.

Supporters of Question 1 want those laws to have the backing of the state constitution, which would make it much harder for future iterations of the state legislature to restrict abortion.

“As we all know, laws can be repealed,” said Katie Curran O’Malley, executive director of the Women’s Law Center of Maryland. “By enshrining this in the Constitution, we protect [abortion] so that it is not at the whim of the political future, if, for whatever reason, our legislature changes from a super majority of Democrats to the opposite.”

Opponents of the ballot measure include those with a long track record of objecting to abortion on moral grounds.

“Rather than taking the extreme step of enshrining the legality of abortion in the Maryland Constitution, we should work to create a culture where no woman feels as though she must choose between the life of her child and a bright future,” the head of the Archdiocese of Baltimore, Archbishop William Lori, wrote in a letter to local Catholics.

Providers say the amendment is important — but that the state needs to expand funding for services.

Partners in Abortion Care in College Park opened its doors after the fall of Roe and is one of the few clinics in the nation that provides third-trimester abortions. It is “trying to figure out how to survive” financially, said Diane Horvath, an obstetrician-gynecologist who co-owns it.

So-called “rage donations” that flowed following the Supreme Court’s ruling have dried up, she said, and Medicaid reimbursement remains lower than the cost of the complex, late-term care the clinic provides.

Horvath said Maryland needs its own abortion fund that provides direct payments to patients and reduces the financial burden on clinics.

“If we want to say we are a receiving, protective state for abortion care, we have to support it with financial resources,” she said.

After the Supreme Court left decisions on how to regulate abortion to the states, a flurry of related ballot measures emerged. Since 2022, abortion rights groups have won in all seven states where voters have directly decided on abortion, including ruby red states like Kansas and Kentucky.

Ten states, spanning the ideological spectrum, have placed abortion on the ballot this November.

Like Maryland, voters in Colorado, Montana and New York will weigh whether to strengthen abortion protections in states where it is already legal.

Limited polling suggests Question 1 in Maryland is headed for a decisive victory. A late-September survey by the University of Maryland, Baltimore County’s Institute of Politics found 69% support the measure, compared to 21% who said they would vote against it and 9% who were undecided.

In a potential sign of its bipartisan support, Question 1 was outperforming Democratic presidential nominee Kamala Harris by 26 points and Democratic Senate candidate Angela Alsobrooks by 39 points. Both candidates have made reproductive rights a major focus of their campaigns against Republican opponents.

A group opposing Question 1 argues the constitutional amendment is too expansive. Health Not Harm says a right to “reproductive freedom” for “every person” would include allowing children to seek gender-affirming care without parental consent.

“Children should not be given the same rights as adults to permanently alter their bodies,” said the group’s chair, Deborah Brocato. “They are too young to understand the long-term consequences of these actions.”

O’Malley said the amendment language is meant to be broad enough to cover abortion, birth control and infertility treatment. But she said that the suggestion it protects gender-affirming care is “a flat-out lie.”

A constitutional protection for abortion in Maryland would send an important signal to other states where the procedure is restricted or banned, supporters of Question 1 say.

Maryland provided 800 abortions last year to individuals from neighboring West Virginia, where a near-total abortion ban is in effect and insurance doesn’t cover the procedure. Hundreds more came from Texas, Florida and South Carolina, according to the Guttmacher Institute, a reproductive health research and policy organization.

Visitors to Women’s Health Center of Maryland near Cumberland can see the West Virginia mountains from an office window, a symbol of why the clinic opened in September 2023. Since then, it has seen over 200 abortion patients, the majority of whom are West Virginians, the clinic says.

“States like Maryland that have the opportunity to change the state’s constitution to articulate that right [to abortion] directly, it is essential for them to do so,” the clinic’s Executive Director Katie Quiñonez-Alonzo said.

Horvath estimated that 80% of the patients who seek care at her College Park clinic later in pregnancy travel from out of state. Many receive a devastating fetal diagnosis or experience barriers to obtaining services sooner. Others are pregnant children.

The amendment, Horvath said, sends a message of “Maryland’s full-throated support for abortion as health care.”