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Montana ballot initiative LR-131 failed muster among voters this week, with ballot counts Thursday morning showing the Montana Born-Alive Infant Protection Act was shot down by more than 22,500 votes.

The Montana secretary of state’s office reported 53% of voters opposed LR-131 and 47% voted in favor. The Associated Press called the result Thursday morning after all precincts had been reported.

If adopted, the referendum would have imposed severe criminal penalties and fines on health care providers who fail to provide life-sustaining care to newborns, including those with fatal health conditions and those born severely premature. Medical providers, health care organizations, reproductive rights groups and parents who have lost infants celebrated the outcome of the ballot question as an affirmation of medical privacy and rejection of government overreach. 

“Today’s win sends a clear message to state leadership: Montanans demand our right to make private health care decisions for ourselves and our families with the help of our trusted medical teams — and without interference from politicians,” Hillary-Anne Crosby, campaign coordinator for the LR-131 opposition group Compassion for Montana Families, said in a Thursday morning statement. “Our coalition is immensely proud of what we accomplished together both in community-building and defeating the extreme, cruel, and unnecessary LR-131, and we will continue to fight any attacks made on Montanans’ constitutional right to make personal, private health care decisions for our families.”

Voters approved another ballot question, C-48, on Tuesday, agreeing to amend the state Constitution to explicitly include electronic data and communications in the provision protecting residents from unreasonable search and seizure. That measure passed overwhelmingly, with 82% of Montanans voting yes and 18% voting no.

The outcome of LR-131, Montana’s only ballot initiative that explicitly mentions abortion, was less clear going into the November election, after it drew vocal debate between Republican lawmakers who supported the initiative and medical providers who said it criminalized palliative care and interfered with the medical decisions of families. 

Proponents who worked to put the Republican-backed measure on the ballot said LR-131 would guarantee that born-alive infants are considered legal persons entitled to medical care, no matter their health prognoses or how they’re delivered, including via abortion. Nationally, anti-abortion coalitions have rallied behind born-alive bills, saying they would add protections for vulnerable infants. 

Opponents of LR-131 said those arguments are false and misleading, in part because infanticide is already illegal in Montana. Rather, medical experts who organized against the referendum, including the Montana Medical Association, Montana Hospital Association, Montana Nurses Association and the state chapter of the American Academy of Pediatrics, said it would penalize health care providers and increase suffering for parents grieving the loss of a child.

“The Montana Medical Association is pleased that the practice of medicine will be left to doctors and patients,” said Lauren Lewis, spokesperson for the Montana Medical Association, in a statement after LR-131’s defeat. “The measure would have criminalized the work of Montana providers and posed very real negative impacts on families experiencing tragic pregnancy complications. These are tragedies, not crimes.”

Republican lawmakers who voted in favor of the measure disputed those characterizations in the final weeks of election season, saying that hospice care for dying infants would be allowed under the statute’s language.  

“The Montana Medical Association is pleased that the practice of medicine will be left to doctors and patients.”

Lauren Lewis, spokesperson for the Montana Medical Association

“It states health care providers must take ‘medically appropriate and reasonable actions to preserve the life and health of a born-alive infant.’ Hospice care is appropriate and it is disingenuous of the opposition to misconstrue and belittle the hospice line of health care,” said Rep. Matt Regier, R-Kalispell, who sponsored the bill to create the referendum, in a recent op-ed. “Medically appropriate and reasonable health care is the treatment you and I expect when we visit our medical provider. Why would we not afford this same care to infants?”

The reproductive rights and medical coalition kicked its opposition to the measure into high gear in the last two months of the campaign, including text- and phone-banking sessions staffed by health care workers directly appealing to voters. Many opponents, including doctors and nurses who spoke against LR-131 at an October press conference, said they feared the text of the referendum would be confusing to voters and contribute to its passage.

But on Election Night, more votes stacked up against the referendum than those in favor of it, in part because of tight margins in typically conservative counties like Ravalli, Lake, Cascade and Flathead. While many rural counties overwhelmingly voted for LR-131, counties that include some of Montana’s largest cities rejected the measure, such as Missoula, Gallatin, Yellowstone, and Lewis and Clark. 

“Our primary goal from Day One was to educate the public on the realities of LR-131 and raise awareness about the threats it posed to Montanans. We accomplished this by uplifting the medical expertise of health care providers and the lived experiences of families who so generously shared their deeply personal stories of loss,” Crosby said. “Without those meaningful conversations and opportunities, we simply could not have triumphed and we are tremendously grateful for their efforts.”

The Montana secretary of state plans to count provisional ballots next week. The office is slated to certify the results of the election by Dec. 5.

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Mara writes about health and human services stories happening in local communities, the Montana statehouse and the court system. She also produces the Shared State podcast in collaboration with MTPR and YPR. Before joining Montana Free Press, Mara worked in podcast and radio production at Slate and WNYC. She was born and raised in Helena, MT and graduated from Seattle University in 2016.