Voters in Alabama and West Virginia voted to approve ballot initatives to establish no constitutional right to public funding for abortions and to abortion access more broadly — even in the case of rape or threat to life of the mother.

The initiatives represent unusual instances where voters themselves and not legislatures voted to make significant changes to state abortion law.

These ballot referendums are part of an overall trend of states reducing access to abortion, sometimes conflicting with the federal right to abortion established in Roe v. Wade.

Most of the focus of the 2018 midterms elections concentrated on hotly-contested Congressional and gubernatorial races, but voters in three states also voted on ballot initatives deciding on whether to reduce access to abortion.

Voters in Alabama and West Virginia voted to approve similar ballot initiatives in the midterm elections to establish no right to publicly-funded abortions, and no guarantee of a right to abortion at all under their states' respective constitutions — even in cases of rape or danger to life of the mother.

Alabama's ballot initative, Amendment 2, passed with 60% of the vote. The amendment proclaims to "recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life" in the state. Both Alabama and West Virginia's amendments codify no right to public funding or even access to abortion at the state level.

A similar measure that sought to ban public funding for abortion in Oregon failed to pass. The two initatives in Alabama and West Virginia represent increasing efforts at the state level to restrict abortion access across the country.

“What we're looking at is a potential rolling back of federal protections of abortion and the decreasing protections in the Alabama and West Virginia constitutions,” Elizabeth Nash, a senior state issues manager at the Guttmacher Institute, told The Washington Post about the initiatives.

Read more: 23 creative ways states are keeping women from getting abortions in the US — that could erode Roe v. Wade without repealing it

These particular changes to state law are unique from other common state-level abortion restrictions, such as regulations on clinics and laws requiring women seeking abortion to attend counseling, in that voters and not legislatures enacted them.

"Usually you see candidates going back-and-forth on abortion or going back-and-forth on whatever the hot social issue is," Nash told the Post. "You don't see it playing out with voters and in ballot initiatives."

Currently, four states have "trigger laws" that automatically ban abortion at the state level in the unlikely event that the landmark Supreme Court decision Roe v. Wadeis overturned. Ten states have pre-Roe abortion bans or restrictions still on their books that are currently un-enforceable because they violate Roe.