Abortion clinics in Missouri have resumed procedures for the first time since 2022, following a constitutional amendment approved by voters in November that enshrines abortion rights. This comeback occurs amid ongoing challenges from conservative state leaders who are attempting to block the amendment and impose restrictive laws. Planned Parenthood, the state’s only non-hospital abortion provider, began services again after a judge temporarily lifted burdensome licensing requirements. Despite popular support for abortion rights, significant obstacles remain as Republicans push legislation to counter the amendment. Advocates express hope but acknowledge the difficult landscape for abortion access in Missouri.
After years of being halted, abortion clinics in the strongly Republican state of Missouri have restarted procedures this week, despite ongoing efforts by conservative state leaders to obstruct a constitutional amendment that solidifies abortion rights, which voters approved in November.
This turn of events marks a significant achievement following a prolonged struggle. Missouri was the first state to implement an abortion ban after the Supreme Court’s decision to overturn Roe v. Wade in 2022. In 2024, it also became the first state to have a near-total ban while successfully passing a citizen-backed abortion rights amendment.
On the day following the constitutional amendment’s approval, abortion rights advocates filed a lawsuit to challenge the ban and other prior restrictions on abortion. Following a judge’s decision on Friday to issue a temporary injunction against state licensing demands for clinics, Planned Parenthood—Missouri’s sole abortion provider outside hospitals—has resumed abortion procedures. The clinics had argued that the imposed requirements were unfeasible for operation.
However, Planned Parenthood will not yet offer abortion pills until the state approves a mandatory reporting plan for any complications experienced by women who take them. Additionally, Republican legislators are actively pursuing numerous bills aimed at limiting or reversing the November amendment.
The ongoing struggle to ensure abortion availability three months after the ballot measure highlights the challenges clinics face, even amid strong voter support for abortion rights.
Despite these hurdles, Emily Wales, president of Planned Parenthood Great Plains, remarked that compared to other states with similar bans, Missouri is advancing at “breakneck speed.”
“For Missourians, it may feel like it has taken a long time,” she added, “and every single day that individuals in the state must travel for abortion access represents a violation of their rights.”
“At the same time,” she continued, “achieving a constitutional change is monumental. We were unsure if we could even tackle this battle, whether we would prevail, or that we could overcome all the obstacles to get on the ballot a year ago.”
Stephanie Bell, a spokesperson for Missouri Stands with Women, one of the organizations that opposed the ballot measure in November, expressed her concerns regarding the judge’s decision to permit “unlicensed and unregulated abortion clinics that prioritize profits over safety.”
“No woman should endure suffering, and no innocent life should be lost, in the name of an industry that refuses accountability,” she stated.
The amendment, approved by nearly 52 percent of Missouri voters, created a constitutional right to abortion up until viability—the stage in pregnancy when it is believed a fetus can survive outside the womb without extraordinary medical assistance.
Judge Jerri Zhang from the Jackson County Circuit Court, covering Kansas City, previously issued an injunction in December, shortly after the amendment took effect, which nullified the near-total ban and suspended several restrictions on abortion. These restrictions included a stipulation requiring a 72-hour waiting period between the initial consultation and the abortion, as well as a requirement for patients to meet with the same physician for both appointments.
This decision allowed hospitals to perform abortions, including in cases of miscarriage care, without fear of criminal repercussions. Nevertheless, Planned Parenthood had initially delayed the resumption of its abortion services because the judge chose not to eliminate the licensing obligations.
In order to obtain a license, clinics had to adhere to a series of regulations, including minimum dimensions for hallways, rooms and doors, extensive reporting mandates, and required pelvic examinations for patients seeking abortion pills, which contradict standard medical practices.
These stringent requirements led most clinics to cease offering abortion services long before the Supreme Court reversed the right to an abortion; state statistics reveal that only 167 abortions were performed in Missouri in 2020, a significant decrease from approximately 5,000 a decade earlier, despite the legality of the procedure.
In her ruling on Friday, Judge Zhang stated that the licensing regulation was discriminatory, “as it does not treat services in abortion facilities the same as other types of similar healthcare, including miscarriage care.”
Planned Parenthood pointed out that Missouri did not impose the same licensing criteria on facilities performing vasectomies, cataract surgeries, liposuction, and other procedures involving general anesthesia. Additionally, private physicians handling miscarriage management utilizing identical medications and methods as abortion clinics faced no similar regulations.
Missouri Attorney General Andrew Bailey, a Republican against abortion rights, is anticipated to challenge the judge’s ruling; a spokesperson did not provide comments when contacted.
The Republican-controlled legislature has introduced more than two dozen bills aiming to impose limitations on the amendment approved by voters in November, some of which would seek voter approval for a contradictory amendment to ban abortion in nearly all circumstances.
Abortion Action Missouri, which supported the abortion rights amendment in November, has announced an expansion of its clinic escorts program. Meanwhile, Coalition Life, the group that opposed the ballot measure, indicated that it would resume protests and sidewalk counseling at the Planned Parenthood clinic in St. Louis.