Not all abortion-rights groups are celebrating a lawsuit to restore access in Missouri
Abortion providers have moved quickly after the Election Day win of Amendment 3, filing a lawsuit to remove Missouri's restrictions and restore abortion services in as quickly as a month. But not all abortion-rights advocates are celebrating.
They say the some of the state's most vulnerable groups — including minors, low-income residents and those later in their pregnancies — are being left out of the effort.
"It's very problematic when we have the people who would need the care the most, who will still be unable to get it," said Justice Gatson, director of Reale Justice Network , a Kansas City-based reproductive justice group that focuses on survivors of violence.
Amendment 3 had the support of a range of groups. With a ballot win secured, a series of legal steps will follow, and likely future political battles. But the groups are not all on the same page about what priorities should come next and what issues to tackle immediately.
Missouri's two regional Planned Parenthood organizations filed the 95-page lawsuit Wednesday, one day after voters approved Amendment 3, which enshrined abortion rights into the state constitution.
The lawsuit, filed in Jackson County Circuit Court, is needed to strike down current laws that are now in violation of the constitution.
The suit not only seeks to end Missouri's enforcement of its ban on nearly all abortions but also a long list of other laws enacted over the years that left only one abortion provider in the state by 2018. It challenges laws such as those mandating that abortion patients see the same doctor 72 hours apart and that abortion clinics meet expensive building specifications to get a license.
But some advocacy groups are disappointed the lawsuit is not seeking to remove what they say are other barriers, such as parental consent requirements for minors and restrictions on abortion coverage in health insurance plans. They also say not enough has been done to protect those seeking later-term abortions.
The groups this week announced that they have formed a coalition, What's Next , to track abortion access under the new amendment and call for a legal strategy that closes gaps in preventing the government from infringing on abortion access.
"It is the responsibility of Amendment 3 leaders to use the full force of the tool they created to protect the people who are most impacted by the harms of the state's abortion bans and restrictions," the coalition said in a news release.
In addition to the Reale Justice Network, the coalition is made up of members from the Missouri Abortion Fund , which help those in need with cost; Right by You , a youth-focused text line connecting Missourians to abortion or birth care; and Patient Forward , which works to secure access to abortion through an entire pregnancy.
Richard Muniz, interim president and CEO of Planned Parenthood Great Rivers , which includes the St. Louis area, said at a press conference Wednesday that the lawsuit seeks to address "the most direct and immediate barriers on abortion access."
Other state laws the lawsuit is seeking to strike down include those that require "medically inaccurate" patient counseling, ban using telemedicine for medication abortions and prevent medical personnel other than doctors from providing abortions.
The providers are also looking to move quickly, hoping to restart abortion services by the time the amendment takes effect Dec. 5. In other states that have passed abortion rights amendments, such as Ohio and Michigan, it has taken several months for judges to decide to strike down some restrictions.
The lawsuit by Missouri providers asks the court to issue a preliminary injunction, which would halt the restrictions until the case is decided.
Planned Parenthood's local staff will be ready by Dec. 5 to provide abortions at its St. Louis clinic in the Central West End, Muniz said. Planned Parenthood Great Plains is preparing to restart services in Columbia and its midtown Kansas City location.
"To be clear, this is only the first step to realizing and fully implementing the protections of Amendment 3," Muniz said when asked about laws on parental consent and health plan coverage. "It's certainly not the last step."
The disagreements on strategy come as Amendment 3 opponents and several legislators have vowed to continue the fight over abortion access and explore a range of options.
"Our work to protect the safety of women and the dignity of life continues. Life supporters will not sit back and watch as Big Abortion works to dismantle all the health and safety protections put in place to protect women and babies," Stephanie Bell, spokesperson for Missouri Stands with Women, said in the aftermath of the Amendment 3 vote.
Pushing for priorities
Among the issues advocacy groups say need to be an immediate priority is access for teens, who currently face several restrictions .
"We've allowed them to be left behind," said Stephanie Kraft Sheley, the founder of Right by You. "And it's just plain wrong to say, 'We'll come back, or we'll help you next, or you can get in line.'"
For minors to obtain an abortion, Missouri law requires consent of one parent or legal guardian and notification of a second parent if possible. Abortion providers are responsible for verifying the necessary documents, which some families might not have, Kraft Sheley said.
The consent requirement also applies to any organizations in Missouri assisting teens obtain abortions.
As an alternative, Missouri law allows a pregnant teen to obtain a "judicial bypass," where a judge decides if the minor is mature enough to act on her own. Advocates argue the process is difficult to navigate and often does little to promote parental involvement.
"All of the data we have is that young people overwhelmingly involve a parent or another trusted adult when they are making this decision," Kraft Sheley said. "Only when they simply do not have anyone to turn to that they feel safe with, do they choose not to."
Kraft Sheley and others also point to another issue they say the lawsuit fails to address: a ban on health insurance coverage for elective abortions, except by an optional rider to be paid by an additional premium.
"If we are going to actually try to restore the availability of abortion appointments, people need to be able to pay for hose appointments," Kraft Sheley said.
There are also questions about the term "fetal viability" in Amendment 3 and the legal challenges it could prompt.
The amendment states that the state government "cannot deny or infringe" upon a person's right to reproductive freedom, defined as "the right to make and carry out decisions about all matters relating to reproductive health care."
The amendment, however, allows the legislature to enact laws regulating abortion after "fetal viability," which it defines as when "there is a significant likelihood of the fetus's sustained survival outside the uterus without the application of extraordinary medical measures." Legislators cannot restrict abortions after viability that are needed "to protect the life or physical or mental health of the pregnant person."
Many advocates are worried what the language could mean for those wanting later-term abortions, "who are often largely young people, people experiencing health emergencies or serious fetal diagnoses, or people who discovered their pregnancies later," said Erika Christensen, co-founder of Patient Forward. Those patients often have to travel out-of-state.
The lawsuit addresses Missouri's post-viability restrictions, arguing that the amendment's more narrow definition of viability must usurp the current one, and that later-term abortions must be allowed to protect the mental health of a pregnant person.
Christensen argues that replacing one definition of viability with another could enshrine the government's ability to interfere in later-term abortions into the constitution.
"The judges have yet another piece of something to look at that shows an important line after which you cross, you can criminalize people and deny them care," she said.
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