CHICAGO — Reeling from a string of defeats, anti-abortion groups and their Republican allies in state governments are using an array of strategies to counter proposed ballot initiatives intended to protect reproductive rights or prevent voters from having a say in the fall elections.

The tactics include attempts to get signatures removed from initiative petitions, legislative pushes for competing ballot measures that could confuse voters and monthslong delays caused by lawsuits over ballot initiative language. Abortion rights advocates say many of the strategies build off ones tested last year in Ohio, where voters eventually passed a constitutional amendment affirming reproductive rights.

The strategies are being used in at least seven states where initiatives aimed at codifying abortion and reproductive rights are proposed for the November ballot.

The fights over planned statewide ballot initiatives are the latest sign of the deep divisions created by the U.S. Supreme Court’s decision two years ago to end a constitutional right to abortion.

This past week, the court issued a ruling in another major abortion case, unanimously upholding access to a drug used in the majority of U.S. abortions, although fights over mifepristone remain active in many states.

The stakes for the proposed ballot initiatives are high for both sides.

Where Republicans control the legislature and enact strict abortion limits, a statewide citizens initiative is often the only avenue for protecting access to abortion and other reproductive rights. Voters have either enshrined abortion rights or turned back attempts to restrict it in all seven states where the question has been on the ballot since 2022.

In South Dakota, lawmakers passed a bill allowing residents to withdraw their signatures on citizen-led petitions. This launched a comprehensive effort by anti-abortion groups to invalidate a proposed abortion rights ballot measure by encouraging endorsers to withdraw signatures.

An Arkansas “Decline to Sign” campaign escalated this month after a conservative advocacy group published the names of the paid canvassers for an abortion rights ballot measure effort. Arkansans for Limited Government, the group behind the ballot measure effort, denounced the move as an intimidation tactic.

In Missouri, Republicans and anti-abortion groups have opposed efforts to restore abortion rights through a constitutional amendment at every step in the process.

Meanwhile, opposition groups in Arizona, Colorado, Florida and Nebraska have tried to create their own ballot amendments to codify existing abortion restrictions, although these efforts failed to gather enough signatures in Florida and Colorado.

Jessie Hill, a law professor at Case Western Reserve University School of Law in Cleveland who served as a consultant to the Issue 1 campaign that codified abortion rights in Ohio, said she had warned about the possibility of competing ballot measures that could confuse voters.

While attempts to keep abortion off the ballot follow a similar blueprint to what she saw in Ohio last year, Hill is closely watching new efforts across the country.

“The anti-abortion side is still trying to figure out what the formula is to defeat these ballot measures,” Hill said.

A strategy document leaked last month shows Arizona Republicans considering several competing measures to enshrine abortion restrictions into the state constitution. Possible petition names include the “Protecting Pregnant Women and Safe Abortions Act,” the “Arizona Abortion and Reproductive Care Act” or the “Arizona Abortion Protection Act.”

The document explicitly details how the alternative measures could undercut a proposal from reproductive rights groups aiming to codify abortion rights through viability, usually around 23 to 24 weeks into pregnancy.

“This leaked document showed a plan to confuse voters through one or multiple competing ballot measures with similar titles,” said Cheryl Bruce, the campaign manager for the group Arizona for Abortion Access.

In Nebraska, anti-abortion groups are countering a planned ballot initiative to protect reproductive rights with two of their own.

Allie Berry, campaign manager of the Nebraska Protect Our Rights campaign, which is intended to protect reproductive rights, said the competing measures are designed to deceive and confuse voters. She said the campaign is working to educate voters on the differences between each of the initiatives.

“If you’re having to resort to deception and confusion, it shows that they realize that most Nebraskans want to protect abortion rights,” she said.

One counter-initiative launched by anti-abortion activists in May seeks to ban abortion at all stages of pregnancy. Called “Now Choose Life,” the petition would grant embryos “personhood.”

Another launched in March would not go that far but instead seeks to codify the state’s existing 12-week abortion ban into the state constitution while giving lawmakers the ability to pass further restrictions in the future.

The petition, called “Protect Women and Children,” has been endorsed by the national anti-abortion group Susan B. Anthony Pro-Life America and others in the state.