How quickly would abortion return to Missouri if voters approve amendment in November?

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Millions of dollars have poured into a campaign to overturn Missouri’s near-total abortion ban, energizing voters across the state. Polling has suggested the constitutional amendment currently has enough support to pass in November

But, if the measure does pass on Nov. 5, what happens in the days, weeks and months after the vote? For all of the excitement, the actual process and timeline of restoring abortion access remains incredibly murky.

Even before it banned nearly all abortions in 2022, Missouri had for decades enacted restrictions on providers that whittled down access to just one clinic by 2019 . Those laws, as well as the abortion ban itself, would likely have to be struck down in court if the amendment, called Amendment 3, passes.

“I do think it will be frustrating to Missourians that they don’t have restored rights the day after the vote,” said Emily Wales, president and CEO of Planned Parenthood Great Plains Votes. “We’ll be working to make clear to the court that the people of Missouri want to have this right restored. They want to have care available again and the courts have to move quickly.”

At the same time, providers would be returning to a Republican-controlled state that has been unabashedly hostile to abortion . Some Republican lawmakers are already floating the idea of filing a measure that would ask voters to strike down the amendment in 2026 if it passes in November.

“We will do everything to protect the innocent life in the womb if Amendment 3 happens to pass,” said Rep. Brian Seitz, a Branson Republican.

Interviews with constitutional experts, lawmakers and abortion rights supporters and opponents emphasized the fact that abortion access will not return to Missouri overnight if the amendment passes. But it would offer a pathway to tear down the ban and years of restrictions, allowing providers to eventually offer the procedure again.

“These would be the strongest protections for private medical decisions related to abortion that we’ve ever had,” said Wales.

The amendment , which would take effect 30 days after the vote, would almost certainly kick off a series of legal battles that will decide how soon those protections will actually allow abortion access.

Similar courtroom fights are playing out across the country in states that have voted to expand abortion access such as Ohio and Michigan. But Missouri would be the first state, or among the first, to overturn a near-total ban — a law that abortion rights supporters will immediately move to strike down after the vote.

A cluster of TRAP laws, or “targeted regulation of abortion providers,” will also be a major hurdle to getting clinics to reopen in the state. Those restrictions include a requirement that women wait 72 hours between seeing a doctor and having an abortion and another that requires doctors to have admitting privileges at a hospital no more than 15 minutes away.

The years-long 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.

Pamela Merritt, a longtime abortion rights activist originally from Missouri now heads Medical Students for Choice, an international group that trains students about reproductive health care. A self-described pessimist, Merritt cautioned that it could be years before clinics reopen in the state.

Missouri, she predicted, could have “abortion in name only” for years.

“What I predict is that we’re likely going to get certain TRAPs struck down, but not enough TRAP to allow…for Planned Parenthood on either side (of the state) to open up a new clinic,” she said. “And that’s not going to be permanent, but that’ll probably be the pattern for five to 10 years.”

Wales, in response, said she understood where Merritt was coming from but that her prediction was not accurate. She pointed to the significant momentum behind the campaign to overturn the ban, saying that the effort has to start somewhere.

“It will be frustrating that every single day, care is not restored,” she said. “Missourians’ lives are at risk, 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.”

A spokesperson for Planned Parenthood Great Rivers, which offers abortion access on the Illinois side of Missouri, also emphasized the urgency of striking down the ban, saying “no one should have to go without care or cross state lines to get it.”

“After Missouri voters pass this ballot measure, we’ll work swiftly to ensure patients can come to our health centers for the broad range of reproductive care, including safe, legal abortion,” spokesperson Nick Dunne said in a statement.

Striking down restrictions

Planned Parenthood Great Plains stopped providing abortions at its Kansas City, Missouri clinic in 2018 amid the web of restrictions passed by state lawmakers.

“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,” said Wales.

If voters approve the amendment in November, supporters will file lawsuits to have those restrictions and the 2022 ban struck down in court for providers to be able to offer abortions.

The effects of the measure were the focus of a lawsuit from abortion opponents who argued the amendment did not sufficiently describe what laws it would repeal. The Missouri Supreme Court rejected that argument and in a 4-3 decision ruled the amendment could stay on the ballot .

The amendment would prohibit lawmakers 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.

A key passage in the amendment that could allow for courts to strike down Missouri’s restrictions 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.”

The language in the ballot measure gives abortion rights supporters “real firepower” to remove the restrictions on providers and puts the burden on state officials to provide a reason for the restrictions, said Mary Ziegler, a law professor at the University of California-Davis.

But the complicating factor is that the state Supreme Court will ultimately have the final say over whether they get struck down, she said.

The first immediate impact of the amendment could center on reproductive care in emergency departments, in which some doctors fear legal consequences for providing care to people in cases such as miscarriages, said Nicole Huberfeld, a law professor and co-director of the Boston University Program on Reproductive Justice.

“Hopefully those go first so that people are no longer dying from abortion bans,” Huberfeld said. But it will be harder for providers to ramp up access to abortion because that involves restarting access to clinics, Huberfeld said.

Betsy Wickstrom, an OB-GYN from Kansas City, emphasized the impact of the ban on emergency situations. She said she’s most concerned about delays in treating ectopic pregnancies, a life-threatening situation in which a pregnancy develops outside of a person’s uterus.

“You can schedule surgery for an ectopic pregnancy in the OR but you have to have clearance from the legal and ethical people to do that because there’s a flicker of what will be a heart,” she said. “Meanwhile, delaying any ectopic pregnancy treatment is asking for disaster.”

Will GOP fight amendment?

The amendment allows but does not require, lawmakers to restrict abortion after viability and the GOP-controlled legislature would almost certainly pass a ban on abortions late in pregnancy.

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

Seitz, the Branson Republican, said that he plans to file a bill next legislative session that would define a fetus as a human upon conception. Seitz, who filed a similar bill last session, claimed that the legislation would “pass court muster,” because it does not specifically mention abortion.

Anti-abortion activists and state lawmakers are also previewing another potential strategy if the amendment passes: a competing ballot measure in 2026.

Sen. Mary Elizabeth Coleman, an Arnold Republican, Sam Lee, an anti-abortion lobbyist in Jefferson City, and Seitz each said that they expect lawmakers to pass legislation to put a constitutional amendment on the ballot to strike down Amendment 3 if it passes.

“That’s certainly going to be a priority of mine,” said Coleman, who did not offer specifics about what the measure would say.

Missouri voters will also decide on Nov. 5 who will become the state’s next governor, a decision that could have significant consequences for access to abortion . Whoever wins will influence how quickly — or slowly — access is restored in the state, including administrative decisions such as approving licenses for abortion providers .

The two major candidates — Republican Lt. Gov. Mike Kehoe and Democratic House Minority Leader Crystal Quade — offer starkly different positions on abortion. Kehoe opposes it while Quade supports the right to choose to end a pregnancy.

Kehoe, in a recent radio interview , promised to work with lawmakers to “protect innocent life” if the amendment passed.

“I will do everything I can to work with legislators and other folks around the state to find ways to make sure we continue to do that in some form or fashion,” Kehoe said. His campaign did not respond to questions for this story.

Quade emphasized that it was critical for voters to elect a governor who would respect the amendment if it’s approved.

“As governor, I’ll work with medical providers to ensure they have what they need to return to the state,” Quade said in a statement. “I’ll always veto legislation that attempts to overturn the will of voters and work to overturn existing laws that make it difficult for people to access care, like laws around waiting periods or hallway size.”

Quade also attacked Kehoe’s stance on abortion, saying Kehoe “won’t listen to voters and will work with lawmakers in Jefferson City to do everything they can to find ways to keep women in Missouri from accessing the healthcare they need.”

Access to abortion is poised to be one of the most consequential issues facing Missourians as the November election inches closer. The abortion rights amendment will be centered in TV ads, on campaign fliers and in political debates.

But the immediate results of that vote — and the timeline of restoring access to the state — are less clear.

Wales, with Planned Parenthood, said the coalition of abortion rights supporters would move quickly to restore access. Providers, she said, have heard numerous stories of people denied care due to the abortion ban.

“As soon as we can end those stories in Missouri, we’re going to do it,” she said.