By CHRISTINE FERNANDO

CHICAGO (AP) — Billboards with the words “STOP Child Gender Surgery.” Pamphlets warning about endangering minors. “PROTECT PARENTS’ RIGHTS” plastered on church bulletins.

That voters in nine states determine whether to enshrine abortion rights in their constitutions, opponents use parental rights and anti-transgender messages to try to undermine support for voting proposals.

The measures do not mention gender-affirming surgeries, and legal experts say changing existing laws on parental notification and consent regarding abortions and gender-affirming care for minors would require court action. But anti-abortion groups hoping to end a defeat at the polls have turned to type of language many Republican candidates across the country are using it in their own campaigns to rally their conservative Christian voters.

“It’s really strange to suggest that this amendment is about things like sex-reassignment surgery for minors,” said Matt Harris, an associate professor of political science at Park University in Parkville, Missouri, a state where abortion rights are on the ballot.

Since the U.S. Supreme Court struck down constitutional protections for abortion, voters in seven states, including conservative Kentucky, mountain and Ohiothey either protected abortion rights or defeated attempts to curtail them.

“If you can’t win by telling the truth, you need a better argument, even if that means capitalizing on the demonization of trans kids,” said Dr. Alex Dworak, a family medicine physician in Omaha. Nebraskawhere anti-abortion groups use the strategy.

Linking abortion rights ballot initiatives with parental rights and gender affirmation is one strategy borrowed from playing cards used in Michigan and Ohiowhere voters nevertheless enshrined the right to abortion in state constitutions.

Both states still require minors to obtain parental consent for abortion, and the new amendments have not yet affected parental involvement or gender-affirming care laws in either state, said David Cohen, a law professor at Drexel University.

“It’s just recycling the same strategiesCohen said.

In addition to Missouri and Nebraska, the states where voters are considering constitutional changes this fall are Montana, Arizona, Colorado, Florida, Maryland, Nevada and South Dakota.

Missouri’s abortion ballot measure has especially become a target. The amendment would prohibit the government from violating “a person’s fundamental right to reproductive freedom.”

Gov. Mike Parson and U.S. Sen. Josh Hawley, both Republicans, argued the proposal would allow minors to get abortions and sex-affirmation surgeries without parental involvement.

The amendment protects reproductive health services, “including, but not limited to,” a list of items such as prenatal care, childbirth, birth control and abortion. It doesn’t mention gender-affirming care, but Missouri state Sen. Mary Elizabeth Coleman, a Republican and attorney for the conservative Thomas More Society, said it’s possible they could be considered reproductive health services.

Several legal experts told The Associated Press that would require a court decision, which is unlikely.

“It would be a real stretch for any court to say that anything related to gender-affirming care counts as reproductive health care,” said Saint Louis University law and gender studies professor Marcia McCormick. She noted that the examples listed as reproductive health care in the Missouri amendment are all directly related to pregnancy.