An attack advertisement by Republican Ohio gubernatorial candidate Vivek Ramaswamy targeting his Democratic opponent, Amy Acton, has sparked criticism within his own party, less than two weeks before November 3 midterm elections in the United States.

The ad features Acton’s estranged mother accusing Acton of being a liar.

Ramaswamy has refused to withdraw the ad, even as senior Republicans have called for its removal.

So what does the ad show, why has it sparked controversy and could it affect Ohio’s governor’s race?

Here is what we know:

What does Vivek Ramaswamy’s advert show?

The ad, which began circulating online on Monday, features Acton’s mother, Donna Arthur, accusing her daughter of lying about her childhood and suggesting she has a mental illness.

“It’s not easy for a mother to say this, but Amy has a serious problem. She is a liar. She lies about her past,” Arthur said in the video.

Arthur also disputed Acton’s account of experiencing homelessness and living in a tent as a child as she urged Ohioans not to vote for her daughter.

However, the ad does not mention that the two have been estranged since 1978 when Acton was 12 and was removed from her mother’s custody after her stepfather was charged with raping her.

Her stepfather pleaded not guilty but failed to appear in court and was never tried. Acton and her brother have publicly described the abuse they experienced as children.

Court records and news reports from the time support key elements of Acton’s account of her childhood. FactCheck.org also found records linking her stepfather to the campground where Acton said her family lived in a tent, contradicting Arthur’s claim that the family never lived there.

Arthur remained married to Acton’s stepfather until his death.

On Tuesday, Ramaswamy’s campaign confirmed it was behind the advertisement and announced plans to spend $4m promoting it.

Why has the advertisement sparked controversy?

On Tuesday, Acton’s campaign released a statement recounting her childhood and a response ad featuring her brother, Phil Stearns.

“I received a lot of abuse, but Amy always got the worst of it,” Stearns said. “She continued to receive that abuse because she knew she had to protect me.”

The use of Acton’s family history has raised questions about how far political campaigns should go in attacking opponents.

David Niven, a political science professor at Ohio’s University of Cincinnati, told Al Jazeera that while campaigns have used relatives to criticise candidates before, this advertisement was particularly unusual.

“We’ve seen family members used before but not in such a deeply personal way,” Niven said.

“So we occasionally see a family member who’s talking about disagreements, you know, talking about a different kind of political outlook, but not this degree of just personal destruction. That’s what’s unprecedented here.”

How have Trump and other Republicans responded?

President Donald Trump and Vice President JD Vance have defended Ramaswamy while other senior Republicans have called for the ad to be withdrawn.

On Thursday, Trump described the ad as “very powerful” and said he had encouraged Ramaswamy to continue running it. Vance told Republicans to “stop whining” about the controversy and focus on winning the elections.

Ohio Governor Mike DeWine, who has endorsed Ramaswamy, called the advertisement “deeply, deeply troubling” and urged its withdrawal although he maintained his endorsement.

Ohio Senator Jon Husted has also distanced himself from the ad.

Niven said the disagreement reflected a broader divide between traditional Republicans and the party’s Trump-aligned wing.

“So there’s a real divide between the Republican Party as it kind of traditionally was, that had something of a standard, and the Republican Party of Trump and Vance that will say anything at any time, regardless of the, you know, propriety of it.”

Ramaswamy has refused to withdraw the ad.

Who are Vivek Ramaswamy and Amy Acton?

Vivek Ramaswamy, 41, is a Republican businessman and former biotechnology executive who unsuccessfully sought the party’s presidential nomination in 2024 before endorsing Trump.

Born and raised in Ohio, he is running for governor with the president’s endorsement.

Amy Acton, 60, is a physician and former director of the Ohio Department of Health who became nationally known for leading the state’s response to the COVID-19 pandemic under DeWine.

Raised in Youngstown, she has spoken publicly about experiencing poverty, homelessness and abuse during childhood.

Neither candidate has previously held elected office.

Could the ad backfire?

The ad could generate sympathy for Acton, particularly among survivors of sexual abuse and their families, according to political analysts.

“Every negative attack carries the risk of backfiring,” Jerry Miller, a professor of communication studies and a political advertising expert at Ohio University, told Al Jazeera.

He explained that campaigns sometimes use controversial advertisements to energise their supporters, even at the risk of alienating other voters.

“I do believe that this ad will generate a degree of empathy, particularly from sexual assault survivors and their families who have had to confront these issues,” he added.

Trump has survived numerous political controversies without losing the support of his base, but Niven said Ramaswamy may find it harder to move past this one.

“The thing that Trump has mastered is he’s always involved in a hundred controversies at a time,” he said. “So you kind of lose track of one controversy because it’s replaced by another one so quickly after.”

But Ramaswamy may not have that advantage.

“The problem for Ramaswamy is this is the only thing people are going to be seeing and hearing. He’s not going to be able to achieve the sort of Trump controversy distraction game,” Niven added.

Why does the controversy matter for Ohio’s governor’s race?

The controversy comes with Acton leading in several recent polls although some surveys suggested a closer contest.

On Friday, the Cook Political Report shifted the race from being a toss-up to leaning towards Acton. It cited the fallout from the advertisement. Its analysts said the race had already been moving towards Acton and the controversy had reinforced their assessment.

The backlash has also generated financial support for Acton, including a $500,000 donation from MK Pritzker, wife of Illinois Governor JB Pritzker.

Hundreds of Ohioans have already cast early ballots, and it remained unclear whether the controversy would influence undecided voters.

“What is already clear is that the controversy has taken on a life of its own, becoming a major factor in this campaign, independent of the ad that sparked it,” Miller told Al Jazeera.

Ohio is an important battleground in the November 3 elections. Once considered a swing state, it has voted for Trump in the past three presidential elections, and Republicans have held the governorship since 2011. A victory for Acton would make her the state’s first Democratic governor in 20 years.