Missouri overturns abortion ban as voters approve a core right to reproductive freedom

Missouri voters overturned the state's abortion ban on Tuesday, enshrining a right to reproductive freedom into the state constitution in a historic election that served as a rebuke of Republican lawmakers who spent decades restricting abortion access.

The passage of an amendment to the Missouri Constitution called Amendment 3 once again legalizes abortion in Missouri two years after state officials swiftly imposed a ban moments after the U.S. Supreme Court struck down the federal right to end a pregnancy in June 2022.

An expansive coalition of abortion rights supporters, civil rights activists, medical professionals and others spent the next two years working meticulously to overturn the prohibition, including gathering more than 380,000 signatures to place the amendment on the ballot. Those efforts culminated in Tuesday's landmark vote, with Missourians rendering a stinging verdict against the state's anti-abortion policy.

Missouri becomes the first state in the nation where voters have ended an abortion ban since the fall of Roe v. Wade – a remarkable achievement in a deeply Republican state where Democrats haven't won a statewide election in six years. The vote marked a stunning defeat for abortion opponents, who steadily chipped away at access ahead of the ban.

"Anti-abortion politicians in our state raced to make Missouri the first state in the country to enact a total ban after the Dobbs decision," Emily Wales, the president and CEO of Planned Parenthood Great Plains Votes, told supporters at a watch party in Kansas City. "Now they get to watch as we take back our rights and become the first state to end a total abortion ban after Dobbs."

The state may eventually become a new, critical abortion access point, joining Kansas to the west and Illinois to the east in offering women a place to legally end their pregnancies as abortion remains fully or mostly illegal across much of the South . And abortion rights are now protected on both sides of the Kansas City metro.

Still, abortion providers caution that rebuilding Missouri's clinic infrastructure could take months or longer. Abortion opponents will also seek to limit the scope of the decision and possibly reverse it at some point in the future.

The Associated Press called the election in favor of Amendment 3 at 10:25 p.m. "Yes" votes were leading "no" votes 53.8% to 46.2%, with about 76% of the vote counted.

"Missouri politicians have spent years passing unnecessary and unfair laws that are affecting Missourians every single day. They have controlled our choices and stolen our autonomy for too long," Selina Sandoval, associate medical director at Planned Parenthood Great Plains Votes, told supporters of the measure in Kansas City in the lead up to the vote.

"But the passing of Amendment 3 is a critical step toward reclaiming control over our personal medical decisions."

Amendment 3 supporters gathered at twin watch parties in Kansas City and St. Louis on Tuesday night. In Kansas City, hundreds of supporters watched returns roll in at the Uptown Theater, cheering as speakers praised the campaign to overturn the ban.

Amendment 3 recognizes a "fundamental right to reproductive freedom," which the measure defines as the right to make decisions "about all matters relating to reproductive health care, including but not limited to prenatal care, childbirth, postpartum care, birth control, abortion care, miscarriage care, and respectful birthing conditions."

The measure prohibits the General Assembly from banning abortion until fetal viability, defined in the measure as the point in pregnancy when there's a significant chance the fetus can survive outside the womb without extraordinary medical measures.

Opponents say the definition opens the door to abortions later in pregnancy , while supporters said such decisions should be left to doctors and patients. Later in pregnancy abortions are rare, with abortions at or after 21 weeks accounting for 1% of abortions in the United States.

"I am here to tell you right now, abortion has nothing to do with reproductive freedom," U.S. Rep. Mark Alford, a Republican, said at a prayer service on Saturday in Pleasant Hill.

"I don't know how smart you have to be to understand that, but it is the antithesis, the complete opposite, of reproduction. It's stopping reproduction."

The amendment allows but does not require, lawmakers to restrict abortion after viability; Republicans in the General Assembly will almost certainly pass a ban on abortions late in pregnancy when its annual legislative session begins in January.

Any post-viability ban would be required to allow at least three exceptions – for the life, physical and mental health of the woman.

Dismantling 'web' of abortion restrictions

The vote left abortion opponents crestfallen. For years, they held the upper hand in Missouri, working with a Republican-controlled General Assembly to whittle away access. By the time the ban took effect in 2022, a sole clinic, located in St. Louis, offered surgical abortions.

A patchwork of regulations effectively caused the number of abortions in Missouri to drop from 6,163 in 2010 to 150 in 2021 before the ban was enacted.

"Missouri is gonna stay a pro-life state," Rep. Brian Seitz, a Branson Republican and a staunch abortion opponent, predicted earlier this year. "We're gonna work very hard to keep it that way."

Republicans, the Catholic Church and other socially conservative churches, along with longtime anti-abortion groups such as Missouri Right to Life, fought the amendment. While proponents enjoyed a large financial advantage and raised more than $30 million, opponents had allies in government.

Missouri Secretary of State Jay Ashcroft and Missouri Attorney General Andrew Bailey attempted multiple times to use and defend inflammatory language in official descriptions that were ultimately struck down by Missouri courts. They sought to cast the proposal as allowing "dangerous" abortions and tried to use magic math to suggest the amendment would significantly cost taxpayers.

Still, opponents nearly succeeded in keeping Amendment 3 off the ballot. They secured a court order from Cole County Circuit Court Judge Christopher Limbaugh, who found it didn't comply with a requirement that ballot measures outline what state laws they would repeal. The Missouri Supreme Court overruled Limbaugh on a 4-3 vote hours before the deadline to finalize the ballot.

Amendment 3's passage marks a turning point in Missouri history. The state has spent roughly three-quarters of its 203-year history as an anti-abortion state. Before the Roe decision in 1973, Missouri had outlawed abortion since at least 1825.

"It really did become like a web of restrictions," Wales said. "It was years of working to comply with the latest nonsensical, medically unnecessary restriction, and then a new thing would be passed, and you'd be trying to comply with that."

Lawsuits ahead

Tuesday's vote almost certainly heralds the start of a protracted struggle to shape the outer limits of Amendment 3's reach.

A host of abortion laws remain on the books in Missouri. Some of those laws, such as the abortion ban, are obviously unconstitutional under the amendment. But others exist in a gray zone that will likely require courts to sort through what passes muster under the new standard.

Amendment 3 states that "the right to reproductive freedom shall not be denied, interfered with, delayed or otherwise restricted unless the government demonstrates that such action is justified by a compelling governmental interest achieved by the least restrictive means."

While basic health and safety rules for clinics are likely constitutional, for instance, a mandatory 72-hour waiting period for abortions and required ultrasounds may be unconstitutional impediments on the right to reproductive freedom .

Lawsuits challenging these statutes are virtually guaranteed.

"I think you're going to see more legal battles, and then the legislature will have to, you know, decide how they want to respond," said Jean Evans, a former executive director of the Missouri Republican Party.

Abortion opponents may also try to overturn Amendment 3 outright.

A statewide vote approved the measure and another could repeal it. The General Assembly has the power to refer constitutional changes to voters and could place a new amendment on a future election. U.S. Sen. Josh Hawley and other Republicans have referenced this possibility, saying the state can vote multiple times on abortion.

Missouri Republicans have had recent success convincing voters to reverse themselves. Voters in 2018 approved Clean Missouri, a governmental reform package that overhauled redistricting in the state. Two years later, voters approved another measure repealing the redistricting reforms.

"Folks who are pro-life are always – are always going to be fighting to keep Missouri a pro-life state, and it doesn't matter what happens or what the margin is," Evans said. "I think there are going to be people who are always going to fight like crazy to keep Missouri a pro-life state."

Ongoing legal fights over regulations and a push by GOP lawmakers to reverse Amendment 3 could create an atmosphere of uncertainty that could slow down abortion providers as they work to open.

Wales said earlier this fall that there will be frustration every day that abortion access isn't restored. But supporters of abortion rights had to start somewhere, she said.

"Missourians' lives are at risk," Wales said, "but we will be telling that to the courts who have to make these decisions, and we will do everything we can to restore access as quickly as possible."