Despite Constitutional Amendment, Abortion Still Out of Reach in Missouri 

The Missouri Supreme Court effectively put a halt to all abortions in the state this week, just months after voters chose to enact a constitutional amendment recognizing reproductive rights in the state.

The case involves restrictions placed on abortion care prior to the passage of the amendment, and even before the U.S. Supreme Court held in Dobbs v. Jackson Women’s Health Organization that there was no federal constitutional right to abortion. Missouri was one of many states that had a trigger law on the books to ban nearly all abortions in the event that the Supreme Court overturned Roe v. Wade. That strict ban came into effect in after the 2022 Dobbs decision, ending access to the procedure in the state.

But in November 2024, voters approved Amendment 3, a ballot measure declaring that the state cannot “deny or infringe upon a person’s fundamental right to reproductive freedom.” Within days of the amendment’s passage, a group of plaintiffs, including Planned Parenthood, challenged the constitutionality of many of the state’s remaining restrictions. These included requirements that clinics have admitting privileges at a hospital no further than 15 minutes away, comply with the standards governing ambulatory surgical centers, perform pelvic exams before every procedure, and make patients wait 72 hours before a procedure was performed.

These restrictions, known as “targeted regulation of abortion provider” or TRAP laws, were passed when the federal Constitution still protected a right to abortion. Around the country, such laws are used to make it harder to provide or access abortion even where the procedure is otherwise legal.

In Missouri, they worked: Before the regulations came into force in 2018, there were 26 clinics in the state. After, only one managed to stay open.

A trial over the constitutionality of Missouri’s abortion restrictions is scheduled for 2026, but the plaintiffs sought to block their enforcement in the interim. The state conceded that the absolute ban was inconsistent with Amendment 3 but argued that the regulations did not run afoul of the new amendment; the laws made women safer without preventing them from getting an abortion, the state insisted. Andrew Bailey, the state’s attorney general, further argued the plaintiffs couldn’t show that they would be irreparably harmed — one of the requirements for the injunction they sought — because patients could get abortion-inducing drugs in the mail or travel out of state even if abortion clinics remained closed. At the time, only three clinics had resumed providing surgical abortions, but only until the 13th week of pregnancy.

In two separate rulings late last year and early this year, state trial Judge Jerri J. Zhang sided with the plaintiffs, blocking many of the restrictions. The regulations didn’t serve a compelling interest or use the least restrictive means of accomplishing the legislature’s goal, she said. Amendment 3 itself specified that an interest that interfered with reproductive freedom could only be compelling, she explained, if it were “for the limited purpose and had the limited effect of improving or maintaining the health” of a person seeking abortion. Moreover, she ruled, some of the requirements likely violated Amendment 3 because they discriminated against abortion, regulating it in ways that other medical services were not.

Missouri then sought a special order directly from the state supreme court called a writ of mandamus to allow the state to continue enforcing its restrictions before the January 2026 trial. This week, the high court granted the state’s request, reasoning that Zhang had applied the wrong standard for evaluating whether the statutes should be blocked.

Historically, Missouri courts applied the same standard for injunctions adopted by the U.S. Court of Appeals for the Eighth Circuit in Dataphase Systems v. C L Systems — and so did Zhang. But the Missouri Supreme Court noted that the Eighth Circuit, in an abortion case called Planned Parenthood v. Rounds, had adopted a more rigorous standard. Under the Dataphase standard, a plaintiff must show only that she has a “fair chance” of prevailing. By contrast, under the Rounds standard, a plaintiff seeking to enjoin a state statute must show that she is likely to prevail on the merits. The state supreme court held that Zhang’s order was wrong because she didn’t apply the standard from Rounds.

The supreme court didn’t hint at how the standard should apply. The state will insist that Zhang should reach a different result under the new standard. The plaintiffs will likely counter that nothing about the substance of the judge’s ruling needs to change significantly, even under a different rule for preliminary injunctions.

Zhang may read the court’s decision as a signal that the Missouri Supreme Court believes that the restrictions should pass muster under Amendment 3. Even if she doesn’t, it’s likely that she won’t issue another injunction for at least a month. In the meantime, it will be very difficult, if not impossible, for people in Missouri to get abortions. Missouri’s remaining clinics canceled all outstanding abortion appointments and advised patients to travel out of state for the procedure after the state supreme court’s decision came down.

The next injunction certainly won’t be the end of the matter either. If the restrictions are permanently blocked after the trial in January, the state is certain to appeal. The supreme court’s brief order doesn’t tell us much about how it might approach the issue then.

What is clear, though, is that simply passing a constitutional amendment protecting reproductive rights is not enough to guarantee access to abortion.

This reality is apparent beyond Missouri. Earlier this month, doctors filed a lawsuit seeking to block remaining abortion restrictions in Arizona, where voters also enacted a constitutional amendment establishing a fundamental right to pre-viability abortion in 2024. The Arizona restrictions include a required pre-visit for an ultrasound and consultation, a 24-hour waiting period thereafter, a telemedicine ban for medication abortions, and a ban on abortions sought because of fetal genetic abnormalities. The state’s 15-week ban was permanently enjoined last month for violating the abortion rights amendment.

The Missouri legislature, meanwhile, has already paved the way for a new ballot measure that would criminalize nearly all abortions, except for those involving certain medical emergencies, fatal fetal abnormalities, and rape and incest in the first 12 weeks of pregnancy. Notably, the ballot measure does not explain that it would functionally ban abortions, instead focusing on the exceptions that would still permit exceptionally narrow categories of abortion.

But whatever voters pass, much will remain in the hands of state supreme courts. Justices in many states, including Missouri and Arizona, face periodic retention elections. These elections are another way that voters can have an impact on the future of reproductive rights.

Mary Ziegler is the Martin Luther King Jr. Professor of Law at the University of California Davis School of Law. Her new book, Personhood: The New Civil War over Reproduction, is now available.

Suggested Citation, Mary Ziegler, Despite Constitutional Amendment, Abortion Still Out of Reach in Missouri, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (May 30, 2025), https://statecourtreport.org/our-work/analysis-opinion/despite-constitutional-amendment-abortion-still-out-reach-missouri