South Dakota voters approved a law in 2020 legalizing the medical use of marijuana, four years after rejecting the idea. Separately in 2020, voters approved an amendment to the South Dakota Constitution to legalize recreational use, but the state Supreme Court nullified it. Voters rejected another proposal in 2022.

The ratio of Republicans to Democrats is similarly lopsided in North Dakota, where the GOP has likewise maintained a trifecta since 1995. And as in South Dakota, voters are fine with medical marijuana, which they approved by a 28-point margin in 2016, but leery of recreational legalization, which they rejected in 2018 and 2022.

With voters declining to enshrine a right to abortion in the State Constitution, South Dakota will continue to have one of the strictest abortion bans in the country.