November will mark the first presidential election since the overturning of Roe v. Wade, posing the biggest test yet over the impact that women’s reproductive health will have up and down the ballot.

Democrats rode anger about the overturning of Roe, which legalized abortion at the federal level, to a surprise victory during the 2022 midterm elections. And the party has racked up more wins in competitive races since then, with their success in large part attributed to the lingering power of the issue.

Now, two years after the Supreme Court’s landmark ruling, Democrats are hoping the issue resonates enough to propel Vice President Harris to the White House.

“Very rarely is an election decided on one issue,” said Christina Reynolds, senior vice president at EMILY’s List, a group dedicated to elected Democratic women in favor of abortion rights. 

“[But] there is a clear lean to one side and that side is the Democrats,” she added. “People are actually understanding and seeing what happens and your best way to deal with this is elect the people who will protect your rights.”

Anti-abortion advocates push back on this argument, pointing to governors with anti-abortion policies in Georgia and Texas. 

“No incumbent pro-life governor or senator lost in 2022, despite facing very vocal pro-abortion Democrats like Stacey Abrams and Beto O’Rourke,” said Emily Erin Davis, vice president of communications at Susan B. Anthony Pro-Life America, 

“Since the 2022 midterms, SBA Pro-Life America has invested significant resources in focus groups and polling to drill down on the most effective political messaging heading into 2024,” she said. 

The two years since the Supreme Court overturned Roe has seen the issue largely kicked back to states, which conservatives and anti-abortion advocates have argued is where it belongs. 

“Democrats won’t be getting the most bang for the buck anymore after this election on this issue simply because each of the states will have defined rules for themselves,” said Ford O’Connell, a Republican strategist. 

But Democrats point to polling that shows the issue playing to their advantage this November. A majority of voters have consistently opposed the Supreme Court’s decision to overturn Roe v. Wade. According to a Marquette Law School poll released last month, 67 percent of respondents said they opposed the decision, while 33 percent said they favored it. 

Meanwhile, a CNN poll released earlier this week found that 52 percent of likely voters said they favored Harris’s approach to voters nationally, while 31 percent said they felt the same about Trump’s approach. 

“We’re working with an electorate that really understands the harms that have come from these Trump abortion bans,” said Olivia Cappello of Planned Parenthood Action Fund. 

But Republicans note that abortion is not the only issue voters are voting on. 

“The issue is important,” said Republican strategist Zack Roday. “But I believe this election will be decided on who people believe can do a better job bringing down costs and keeping us safe.” 

According to data released by the Pew Research Center, 81 percent of voters said the economy was their top issue, followed by 65 percent who said the same about health care. Fifty one percent said the same about abortion. 

Democrats point to their past success in the 2022 midterm elections following the overturning of Roe. The midterm elections that year saw the expected red wave fail to materialize and a number of abortion-related ballot measures in red and blue states passing in favor of maintaining abortion access. 

This year, abortion-related measures are on the ballot in Arizona, Nevada, Colorado, Montana, South Dakota, Nebraska, Missouri, Maryland, New York and Florida. 

“On the ballot measure front, voters recognize that they have an opportunity in states that have direct democracy to make swift change in the state of abortion access in their state,” Cappello said. 

And unlike in 2022, access to in vitro fertilization is a central part of the conversation surrounding reproductive health care. Democrats have sought to tie Republicans to efforts in states like Alabama to limit or restrict access to the procedure. 

But many Republicans, including Trump, have expressed their support for the procedure. On Wednesday, the Trump campaign said if elected the former president would support “universal access” to IVF. 

“The stance that Trump has taken is the majority feeling within the Republican Party because at the end of the day, IVF is about life,” O’Connell said. 

But both candidates have addressed abortion and reproductive health. During a rally in Pennsylvania earlier this week, Trump predicted that under his administration women “will be happy, healthy, confident and free. You will no longer be thinking about abortion.”

Harris has repeatedly hammered Trump on the issue, citing his appointment of conservative judges to the Supreme Court. On Tuesday, she called to eliminate the filibuster to codify abortion rights in the Constitution. 

Earlier this month during a campaign stop in the battleground state of Georgia, Harris highlighted the stories of two women, who Harris said died as a result of the state’s abortion ban passed by Republicans following the overturning of Roe v. Wade.

ProPublica first reported on the deaths of Amber Thurman and Candi Miller. Thurman waited 20 hours in a suburban Atlanta hospital after seeking medical care for an incomplete abortion, and, according to a state medical board review, died largely because of the hospital’s delay in treating her. Miller died after she did not seek medical care for complications from abortion medicine. Her family said she was fearful of getting medical treatment when it was clear the abortion was not complete.

“Good policy, logical policy, moral policy, humane policy is about saying a healthcare provider will only start providing that care when you’re about to die?” Harris said. 

Georgia’s six-week ban on the procedure does have exceptions to save the life of the mother, but opponents of the ban say it creates confusion for doctors. 

Earlier this week SBA Pro-Life America’s partner, the Women Speak Out PAC, launched a  $500,000 television and digital ad campaign in Georgia, responding to Harris. The group accused Democrats, including Vice President Harris, of spreading “deadly misinformation” about the women’s deaths.

Conservatives and groups like SBA Pro-Life America are pushing Republicans to paint their Democratic counterparts are radical and extreme on the issue, something they have worked to do in the past. 

“Many GOP candidates even won by double-digit margins. Republicans will see more victories going forward if they emphasize support for pro-life protections, communicate on the issue with compassion and contrast their position with the deeply unpopular Democrat agenda for unlimited abortion in the seventh, eighth, and ninth months of pregnancy,” Davis said. 

Roday noted that this cycle both sides find themselves in “uncertain terrain” on the issue given the top of the ticket. 

“Simply because of it being a presidential [election], I do believe it’s a whole new dynamic,” he said.