Three months after Missouri voters enshrined reproductive rights in the state constitution, abortion remains unavailable as the state’s main provider fights legal hurdles to resume offering the procedure.
At the same time, opponents of abortion in the state Legislature, stung by the passage of Amendment 3 in November, have filed a raft of bills aimed at thwarting implementation of the measure or undercutting its goals while they try to find a unified strategy to prevent the return of abortion services.
This week, state lawmakers held a hearing on a conservative-backed plan to put a new amendment on the ballot that would block most abortions. If passed by the General Assembly, the measure could go to voters as soon as this year.
The proposed amendment would ban abortion except for in medical emergencies, when a fetus has abnormalities, or in cases of rape or incest, with rape or incest cases requiring a police report and subject to a 12-week limit. It would also prohibit public funding for abortions. What’s more, it would ban providing surgeries, hormones or drugs to assist a child with a gender transition, procedures that are already illegal in Missouri.
At a hearing on the proposed amendment before the House Children and Families committee on Tuesday, its sponsor, state Rep. Melanie Stinnett, a Republican from Springfield, acknowledged that some might say she was trying to subvert the people’s will. But Stinnett said she’d heard concerns about the language in Amendment 3 and that this was an attempt to clarify the state’s abortion laws.
Stinnett said voters might not have understood what they were voting for.
Some members of the committee pushed back.
“Did voters know what they were voting for when they voted for you?” asked state Rep. Marlene Terry, a Democrat from the St. Louis suburbs.
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The delay in providing abortion access after the election was “a very positive turn of events” that gave conservative legislators time to strategize, state Rep. Brian Seitz, a Republican from Branson, said in an interview. He said it gave his party “time to chip away at certain aspects of Amendment 3.”
Missouri had heavily restricted abortion access long before the U.S. Supreme Court eliminated the federal right to abortion by striking down Roe v. Wade, with the state’s strict regulations leaving only one clinic — Planned Parenthood in St. Louis — operational by 2018. In 2019, the state passed a trigger law that would ban abortion entirely if Roe fell, except in cases of medical emergencies but with no exemptions for rape or incest. That ban took effect in 2022.
Planned Parenthood stopped performing any abortions in Missouri at that time, and many people traveled to neighboring states to access abortions. In 2023, about 2,850 Missourians obtained abortions in Kansas, while about 8,750 sought the procedure in Illinois, according to the Guttmacher Institute.
In response, a massive campaign gathered hundreds of thousands of signatures to put abortion rights on the ballot. Amendment 3 — which established a fundamental right to reproductive freedom, including in making decisions about prenatal care, childbirth, postpartum care, birth control, abortion care, miscarriage care and respectful birthing conditions — passed by a 51.6% to 48.4% margin.
The amendment guaranteed the right to abortion up to the point of fetal viability, which it defined as the stage at which, in the judgment of a treating physician, a fetus could survive outside the womb without extraordinary medical measures. While the amendment allowed the state legislature to regulate abortion after viability, it required that any such regulations not interfere with abortions necessary to protect the life or health of the pregnant person.
After the amendment took effect in December, Planned Parenthood said it was ready to begin providing abortions at three locations across the state but that it felt limited by Missouri’s ban and other regulations targeting abortion providers, which are designed to make it harder for clinics to operate. It sued.
In December, a state court judge in Kansas City temporarily blocked the ban and most of the rules, including the mandatory 72-hour waiting period and bans based on gestational age. The final outcome will be determined at trial, which is scheduled to begin in January 2026.
The state court ruling left several abortion restrictions in place. Those include strict structural requirements for clinics — such as specific hallway, room and door dimensions — and a mandate that providers perform invasive pelvic exams before prescribing abortion medication.
Abortion rights advocates argue these regulations are medically unnecessary and create barriers to care. At a hearing last week in Kansas City, a lawyer for Planned Parenthood asked the judge to reconsider, emphasizing that the restrictions make it impossible for clinics to resume offering full services.
Planned Parenthood’s lawyer argued that it was because of the licensing requirement that abortion access had been confined to one location in St. Louis in the final years of Roe, and that “such extreme restriction on abortion access is not the result contemplated” by those who voted for the amendment.
The state’s solicitor general, Josh Divine, argued that Planned Parenthood could have requested waivers for the regulations instead of challenging them in court. He noted that the state has granted such waivers in the past, but Planned Parenthood did not submit a request. The judge gave both sides until the end of this week to submit further briefings before her ruling.
The delay has had another effect: fueling division among abortion rights supporters. Some of them opposed Amendment 3, arguing it didn’t go far enough and gave the state too much power to regulate abortion. They note that while the amendment guarantees the right to abortion before fetal viability, it also cements the state’s authority to impose restrictions afterward, giving abortion foes a foothold. (Supporters say they settled on the language as a compromise they believed would appeal to a broad majority of voters, and that an amendment offering unrestricted access to abortion would not have succeeded.)
Representatives for Planned Parenthood did not respond to requests for comment.
The effort to tie abortion to transgender rights mirrors the preelection campaign, where abortion opponents deliberately conflated the two issues on billboards and in radio ads. Critics said this strategy was a distraction — an attempt to shift focus from abortion rights, which had strong voter support, by exploiting voter unease over transgender rights.
Jamille Fields Allsbrook, a professor at Saint Louis University School of Law and a former policy analyst for Planned Parenthood Federation of America, sees Republicans taking a two-pronged approach in response to Missouri’s abortion amendment. With President Donald Trump back in power, she expects them to push familiar strategies, like cutting off Medicaid and Title X funding to clinics that provide abortions.
She said she had expected the Republicans to attack abortion rights in “sneaky, more maneuvering ways” like redefining fetal viability or pushing fetal personhood laws, measures that might sound reasonable to voters but still effectively restrict access.
But she said she was surprised by the Republican effort to simply gut Amendment 3.
“Seems naive politically to try to advance the exact same thing that voters rejected,” she said. “Either they don’t believe that voters have already spoken out loudly and clearly or they think that voters are not smart enough to recognize what they’re trying to do, which is undermine the will of the people.”
