Missouri Votes to Overturn Abortion Ban, But No Clinics Remain in the State

Missouri voters passed a pro-choice ballot measure on Tuesday night, becoming the first state since the Dobbs decision to vote to overturn a near-total abortion ban. Amendment 3 was one of 10 abortion-related statewide initiatives on the ballot this election. As of 11:30 p.m. ET, the vote tally was 54% yes to 46% no, according to the Associated Press.

Amendment 3 codifies the right to abortion until fetal viability in the state constitution, and could lead to the restoration of abortion access in a state where the procedure is banned in almost all circumstances—the operative word being could. It takes effect in 30 days, then the next phase of the battle begins: implementation of the amendment, including lawsuits to officially overturn the 2022 ban, and working to get the state’s last abortion clinic licensed and back up and running.

Following a flood of restrictions, the state was down to just one clinic in 2019: Planned Parenthood of St. Louis. If that clinic wants to provide abortions again, it must either have a doctor with (unnecessary) admitting privileges at a local hospital, or have advocates sue to have that law struck down under the amendment. These disputes will ultimately land at the state Supreme Court.

The state health department also revoked the former clinic’s license to operate in 2019 and re-licensed it in 2022 after a court order. But the clinic hasn’t offered abortions since 2022 and would need a new license to re-open. It’s expected that Republican Lt. Gov. Mike Kehoe will be the next governor and the decision whether to grant a license would fall to his appointees.

A more immediate impact of Amendment 3 could be improved access to care in emergency rooms. Women across the country, including in Missouri, have shared their experiences of delays in care because doctors are afraid they’ll face criminal penalties if they end someone’s pregnancy.

Opposition to Amendment 3 could also continue in the Republican-controlled legislature with potential attempts to override it. Amendment 3 was a citizen-proposed ballot initiative, but the state also allows legislature-proposed amendments, so lawmakers could move to send a repeal initiative to voters in 2026. The state has repealed other citizen-led amendments this way, including one regarding a redistricting measure that passed in 2018.

State Sen. Mary Elizabeth Coleman (R) told the Missouri Independent in September “I think you will see efforts, win or lose, for Missourians to get another say in this.” State Rep. Brian Seitz told the Kansas City Star, “We will do everything to protect the innocent life in the womb if Amendment 3 happens to pass.” Seitz also said he planned to file a bill that would define fertilized eggs as people, a potential attempt to get the court to overturn the Amendment on fetal personhood grounds.

The measure faced fierce opposition. In September, a lawsuit from conservative legislators and activists nearly knocked it off the ballot, but the state Supreme Court ruled 4-3 that it could stay.

Missouri Sen. Josh Hawley (R) also tried to argue in September that Amendment 3 would somehow permit gender-affirming medical care for minors without their parents’ permission. It’s a specious claim, but it reflects a Republican strategy we saw throughout the entire election cycle: attempting to deflect attention from abortion bans to transgender people.

It’s been a long road for advocates of Amendment 3, and the fight will continue.