Virginia voters will decide in November whether they want to enshrine the right to third-trimester abortions into the commonwealth’s constitution via ballot initiative, which would make it the most permissive state with respect to abortion in the Southeast.
Virginia is one of three states that will vote on enshrining a fundamental right to abortion and other reproductive health matters into their state constitutions in the midterm elections. Such ballot measures have remade abortion law across the United States since the Supreme Court overturned Roe v. Wade in 2022.
But Virginia is the only state with an amendment on the ballot this year that specifically protects abortion access during the third trimester and after fetal viability, which is typically around 21 weeks of pregnancy or the point when most physicians estimate a fetus can survive birth with proper medical care.
The amendment, Question 1, would establish a “fundamental right to reproductive freedom” for all individuals, regardless of age, and includes decisions about “prenatal care, childbirth, postpartum care, contraception, abortion care, miscarriage management, and fertility care.”
The amendment would also only allow the state to impose any safety regulations only “by the least restrictive means” so long as they do not impinge on the “individual’s autonomous decision making.”
Virginia is already the only state in the Southeast that allows abortion up to 28 weeks of pregnancy, the start of the third trimester. According to the abortion-rights Guttmacher Institute, there were 39,500 abortions in Virginia in 2025, roughly 8,400 of which were performed on out-of-state residents.
Nationally, 1% of abortions, roughly 112,000 annually, are performed after 21 weeks of pregnancy.
Here is what you need to know about Question 1 and the abortion rights amendment.
What does the amendment say about third-trimester abortion?
The text of the amendment says the legislature can enact certain restrictions on third-trimester abortions, but only under a narrow set of circumstances.
The amendment says the legislature can regulate third-trimester abortions, but “in no circumstances shall the Commonwealth prohibit an abortion that in the professional judgment of a physician is medically indicated to protect the life or physical or mental health of the pregnant individual” or if the fetus is deemed not viable.
Opponents of the amendment argue that the mental health exception for later-in-pregnancy abortion opens the door for women to use generalized anxiety or other less severe mental health concerns to seek an abortion.
How does the amendment compare to current law?
Passing Question 1 would significantly loosen Virginia’s safety restrictions on abortions later in pregnancy and abortions for minors in the state.
Third-trimester abortions under the current Virginia law must be approved by two additional consulting physicians, who must attest “based upon their best clinical judgment, the continuation of the pregnancy is likely to result in the death of the woman or substantially and irremediably impair the mental or physical health of the woman.” The language of the amendment, however, specifies that a third-trimester abortion only needs “the professional judgement of a physician,” making the choice only up to the patient and her physician.
Should the amendment pass, other safety measures supported by anti-abortion advocates will likely be challenged and overturned in state court, as has happened in other states with abortion amendments, such as Missouri and Ohio.
The current statute in Virginia requires that second- and third-trimester abortions be performed in a hospital setting, which, under the new amendment, could be interpreted as an undue burden on abortion access in subsequent legal challenges.
Current law also requires that hospital facilities performing abortions must have life-saving support available for the mother in case there are complications, as well as for the fetus in case it is born alive. Anti-abortion advocates also argue this would likely be subject to litigation and overturned by the courts as well if the amendment becomes law.
Virginia law also requires parental notification and consent for a minor’s abortion, which abortion opponents say is essential for protecting girls and young women from sexual abuse. Because the amendment uses the words “individual” autonomy rather than “adult,” laws affecting abortion access for minors will also likely be challenged in court.
What do doctors say in support of the amendment?
More than 300 medical professionals in Virginia signed an open letter in September endorsing the amendment, saying that patients and clinicians ought to be able to make decisions about reproductive care “without fear of government interference or criminal punishment.”
The abortion-rights coalition, supported by the clinician lobbying group Committee to Protect Health Care, did not address the safety concerns about abortions later in pregnancy or with parental consent. Rather, they focused on patient autonomy.
“Right now, the Virginia Constitution doesn’t recognize the right to reproductive health care,” the coalition wrote. “That means that politicians have the ability to restrict and criminalize certain care, or even ban it entirely. That’s why we need this amendment — to prevent Virginia politicians from taking away our freedom to make our own health care decisions.”
What do doctors say against the amendment?
Anti-abortion physicians have been some of the loudest opponents to the abortion-rights amendment in Virginia, arguing that the loose language around third-trimester abortions puts women at risk.
Dr. Christina Francis, president of the American Association of Pro-Life Obstetricians and Gynecologists, said during a rally on Friday at the House of Delegates in Richmond that the amendment “would open the door to unlicensed facilities providing abortions in the third trimester.”
“These are very risky procedures, not just for the baby whose life has ended, but for the mom as well,” Francis said. “The risk of dying from a third-trimester abortion is higher than the risk of dying from a normal delivery.”
Dr. Timothy Boley, a maternal-fetal medicine specialist who spoke at the event, said he was concerned that the amendment does not allow for enough state oversight of abortion providers and facilities.
“You’re just trusting the doctors to do what they should be doing, and we know that doesn’t always happen,” Boley said.
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[ H/T Washington Examiner ]
