Ohio voters enshrined abortion rights in their state’s Constitution, a boon for Democrats running on the issue and complicating Republicans’ campaign messages with the approach of the 2024 elections.

The amendment, known as Issue 1, was adopted by a margin of 59% to 41% with a third of the vote counted in Tuesday’s general election in Ohio, according to the Associated Press. It’s the only state with an abortion issue on the ballot this fall. The amendment prevents the state from interfering with reproductive decisions up to about 23 weeks of pregnancy.

Supporters have said the amendment takes an important decision away from the government and back into the hands of individuals and was needed after Ohio Republicans enacted one of the most restrictive bans in the country in 2019. That law bans abortions after about six weeks — before many women know they’re pregnant with no exceptions.

Since the US Supreme Court overturned the 1973 Roe v. Wade decision last year, anti-abortion referendums were defeated in Kansas, Kentucky and Montana, and rights measures passed in California, Michigan and Vermont. Earlier this year, a Wisconsin state supreme court candidate who pledged to back abortion rights won by a wide margin with unusually high turnout.

Passing the amendment in Ohio, a state that Donald Trump won twice, shows abortion can be a motivating issue for Democrats and younger voters while animating many Republicans, especially GOP women, said veteran Democratic strategist Doug Sosnik.

“It’s like a freight train that’s picked up even more speed on the issue,” Sosnik said.

Mark Caleb Smith, director of the Center for Political Studies at Cedarville University in Ohio, said Issue 1 supporters benefited because opponents were outspent on advertising, $24.6 million to $16.3 million, according to AdImpact. Another ballot issue to legalize recreational marijuana likely helped encourage turnout of younger voters, supporters said.

Abortion opponents, led by Republican Governor Mike DeWine, had argued that Issue 1 was too broad and “goes too far” by allowing abortion at any time up until birth.

While abortion was not specifically on the ballot in Virginia on Tuesday, it figured in hotly contested races that will determine which party controls the legislature. Glenn Youngkin, the Republican governor who campaigned to give the full control of the state government, supports a 15-week abortion ban with exceptions for rape, incest and life of the mother.

The successful vote for Issue 1 comes after several trials. Abortion rights groups accused opponents of waging a “disinformation campaign” to defeat the measure, including approving ballot language that used the term “unborn child” instead of “fetus.” Ohio Republicans also tried using a special election in August to raise the threshold for passing an amendment to 60% from a simple majority. Voters soundly rejected it.

Ohio Department of Health data show that the vast majority, or 89%, of the 18,488 abortions in the state last year were performed before 13 weeks of pregnancy, and only 107 — or 0.6% — were done at 21 weeks and over. Often in those cases, the fetus couldn’t survive or the mother’s life was in jeopardy.

Michael Bloomberg, the founder and majority owner of Bloomberg LP, the parent of Bloomberg News, gave $1 million to the campaign supporting Issue 1.