JEFFERSON CITY, Mo. (AP) — Missouri voters will decide in November whether to guarantee a right to abortion with a constitutional amendment that would reverse the state’s near-total ban.

The secretary of state’s office certified Tuesday that an initiative petition received more than enough valid signatures from registered voters to qualify for the general election. It will need approval from a majority of voters to become enshrined in the state constitution.

If passed, the Missouri initiative would “do something that no other state has done before — end a total abortion ban at the ballot box,” said Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, which is sponsoring the measure with significant financial support from Planned Parenthood affiliates and the American Civil Liberties Union.

Missouri will join at least a half-dozen states voting on abortion rights during the presidential election. Arizona’s secretary of state certified an abortion-rights measure for the ballot on Monday. Measures also will go before voters in Colorado, Florida, Maryland, Nevada and South Dakota. While not explicitly addressing abortion rights, a New York ballot measure would bar discrimination based on “pregnancy outcomes” and “reproductive healthcare,” among other things.

Missouri Secretary of State Jay Ashcroft said there also were sufficient signatures to hold November elections on initiatives raising the state’s minimum wage to $15 an hour and legalizing sports betting.

But he said an initiative authorizing a casino at the popular Lake of the Ozarks tourist destination fell short of the required threshold. Casino backers said they remain confident they got enough signature and attorneys are assessing their next steps.

The initiatives will appear on the ballot alongside candidates for top offices, including governor, U.S. Senate and the state legislature, meaning abortion is likely to become an even greater political issue in the state.

The campaign of the Republican gubernatorial nominee, Lt. Gov. Mike Kehoe, denounced the abortion ballot measure on Tuesday as an “extreme proposal funded by out-of-state liberals.”

“Mike Kehoe opposes the radical Left’s attempts to rewrite Missouri’s long history of protecting life,” his campaign said in a statement.

The Democratic gubernatorial nominee, House Minority Leader Crystal Quade, praised the measure and said she would “ensure this ballot initiative gets implemented to its fullest extent.“

The U.S. Supreme Court overturned a nationwide right to abortion in 2022, sparking a state-by-state battle in legislatures and a new push to let voters decide the issue. Since the ruling, most Republican-controlled states have new abortion restrictions in effect while most Democratic-led states have measures protecting abortion access.

Abortion rights supporters have prevailed in all seven states that already had decided ballot measures since 2022: California, Kansas, Kentucky, Michigan, Montana, Ohio and Vermont.

The high court’s decision overturning its Roe v. Wade precedent triggered a 2019 Missouri law to take effect prohibiting abortion “except in cases of medical emergency.” That law makes it a felony punishable by five to 15 years in prison to perform or induce an abortion, though a woman undergoing an abortion cannot be prosecuted.

Since then, almost no abortions have occurred at Missouri facilities. But that doesn’t mean Missouri residents aren’t having abortions. They could receive abortion pills from out of state or travel to clinics elsewhere, including ones just across the border in Illinois and Kansas.

The Missouri ballot measure would create a right to abortion until a fetus could likely survive outside the womb without extraordinary medical measures. Fetal viability generally has been considered to be around 23 or 24 weeks into pregnancy but has shifted downward with medical advances. The ballot measure would allow abortions after fetal viability if a health care professional determines it’s necessary to protect the life or physical or mental health of the pregnant woman.

“The undeniable truth is this measure legalizes abortion throughout any stage of the pregnancy,” said Stephanie Bell, spokeswoman for Missouri Stands with Women, which opposes the ballot measure.

The number of states considering abortion ballot measures could grow. Officials in Montana and Nebraska have yet to determine whether proposed abortion-rights initiatives qualified for a November vote. Nebraska officials also are evaluating a competing constitutional amendment that would enshrine the state’s current ban on most abortions after 12 weeks of pregnancy. And a legal battle is ongoing over an Arkansas initiative.

Campaign committees supporting Missouri’s abortion-rights and sports betting measures each already have spent more than $5 million, with millions more in spending expected. The sports betting initiative has been financed largely by the parent companies of DraftKings and FanDuel but also is backed by Missouri’s six professional sports teams, which would control onsite betting and advertising near their stadiums and arenas.

Thirty-eight states and the District of Columbia already offer some form of sports wagering, which has expanded rapidly since the U.S. Supreme Court cleared the way for it in 2018. Missouri sports teams turned to the initiative process after efforts to legalize sports betting were repeatedly thwarted in the state Senate.

“Missouri is now just one step away from joining most other states in legalizing sports betting and being able to provide millions of dollars to Missouri classrooms,” St. Louis Cardinals President Bill DeWitt III said in a statement Tuesday.

The minimum wage measure would increase the state’s current rate of $12.30 an hour to $13.75 an hour in 2025 and $15 an hour by 2026, with annual adjustments for inflation after that. It also would require employers to provide paid sick leave.