How Are Advocates Using State Reproductive Freedom Amendments? 

A Missouri trial court last month largely sided with groups challenging the constitutionality of most of the state’s abortion restrictions — including a total ban, several gestational bans, targeted regulations of abortion providers, mandatory counseling and waiting periods, and a telemedicine ban. While state officials have already appealed the ruling, the early success is a watershed moment given that Missouri was the first state to enact a near-total abortion ban following the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization declaring there is no federal constitutional right to abortion.

What changed in the last four years? In 2024, Missouri voters enacted an amendment codifying the right to reproductive freedom in the state constitution and advocates immediately sought to enforce it through litigation. Missouri is 1 of 10 states where, since Dobbs, voters have enacted constitutional amendments via ballot measure to protect abortion and reproductive rights. Two additional states are poised to do the same this November: Nevada, where the amendment passed the first of two necessary votes in 2024, and Virginia.

Over the past two and a half years, advocates have invoked these reproductive freedom amendments primarily in cases seeking to block abortion restrictions. Thus far, challenges against bans and restrictions on abortion care have successfully secured lower court injunctions, but there has yet to be a state supreme court decision on the merits of a claim or otherwise weighing in on questions of constitutional meaning and interpretation of one of the new amendments. Thus, how the amendments will shape constitutional doctrine in these states, particularly beyond the abortion context, is still developing. 

To date, however, nine court decisions have addressed the constitutionality of various abortion restrictions under the new amendments.

Challengers have prevailed both in states that had few legal restrictions on abortion before their amendments were passed (Arizona, Michigan) and in those that had nearly complete bans on their books after Dobbs (Missouri, Ohio). Several kinds of abortion bans and laws interfering with patient access have been found to violate the new amendments. The kinds of laws that courts have universally found unconstitutional under the amendments include gestational limits; bans on seeking an abortion for reasons related to race, sex, or fetal diagnosis; mandated waiting periods; laws that require biased counseling or ultrasounds; prohibition of telemedicine abortion care; and laws mandating particular methods for disposal of fetal remains.

In contrast, courts have reached differing conclusions in cases challenging laws that limit the performance of abortion care to physicians: A Michigan trial court found that such a law violated the state’s reproductive freedom amendment, but in Missouri a trial court upheld a similar limitation. Both states’ amendments require application of strict scrutiny and only recognize protecting the health of pregnant patients based on evidence-based medicine and clinical standards of care as a compelling government interest. The divergent outcomes, however, reflect the Michigan court’s focus on how the physician-only law interfered with patient’s right to abortion, while the Missouri court was convinced by testimony that there was a need for physicians, rather than advanced practice clinicians, to provide some abortion care. Although both decisions have been appealed, the lower court decisions are a reminder that even with explicit constitutional protections for abortion, courts may come to different conclusions about whether restrictions are supported by enough evidence to justify limiting access to abortion care. 

Courts also are being asked to consider how the amendments apply to minors seeking access to reproductive care. So far, a challenge to Missouri’s parental consent and notification requirement was dismissed without prejudice on the basis that the plaintiff organization lacked standing; a similar challenge in Colorado is still in early stages of litigation.

At the same time, opponents of reproductive freedom are actively generating arguments and cases about minors to advance their own cause. In Michigan, an antiabortion organization sought to overturn the state’s reproductive freedom amendment in a legal challenge arguing that the amendment undermined parental rights, both in the context of abortion and gender-affirming care. (The case was dismissed based on standing.) And in Virginia, an antiabortion group challenged a proposed amendment as misleading because it would terminate Virginia’s parental consent laws for both abortion and gender-affirming care. Meanwhile, an Ohio juvenile division judge is seeking to circumvent the state’s reproductive freedom amendment by arguing it conflicts with his own duty to adjudicate requests by minors to obtain an abortion, a process known as judicial bypass.

These are far from the first instances of efforts to undermine reproductive freedom amendments. Opponents have (unsuccessfully) challenged the ballot language describing the amendments in multiple states. And in Missouri, just two years after its amendment’s passage, opponents have placed a new proposed amendment on this year’s ballot that would repeal the state’s current amendment protecting abortion care and establish a 12-week gestational ban. That amendment would also prohibit gender-affirming care for minors. Additionally, in Arizona, Michigan, Montana, and Ohio, lawmakers who oppose abortion have continued to introduce antiabortion bills despite the clear intent of voters in those states to protect and expand access through ratification of constitutional protections for abortion. And opponents are coming up with additional strategies to eradicate constitutional protections for abortion.

Litigation around abortion care is not the only path forward for enforcing the amendments and leveraging them to build state constitutional jurisprudence. Most amendments contain language protecting a host of rights related to pregnancy, procreation, and reproductive autonomy generally. Across multiple states, courts are now defining the scope of those protections.

In Vermont, advocates invoked the state’s reproductive freedom amendment in a lawsuit alleging that the state’s child welfare system violated a pregnant woman’s reproductive rights when it conducted an unlawful assessment of her parental capacity, obtained a court order for custody of her fetus, coerced her to undergo an involuntary Cesarean surgery, and then retained custody of her newborn baby for seven months. The plaintiff alleged that the state’s conduct was part of its practice of surveilling a list of pregnant Vermonters it considered “high risk, ” and challenged this practice under the amendment. While the trial court dismissed those claims for lack of standing because plaintiff had not alleged she was on the “high risk” list, it held that the amendment was self-executing, meaning people can bring independent lawsuits to enforce it.

In Maryland, the supreme court referenced the state’s reproductive freedom amendment in a ruling overturning a woman’s conviction for murder related to a stillbirth. In the criminal case, the prosecution had introduced evidence that the woman searched for information about abortion while she was pregnant, but the court held that the search was inadmissible, citing to Maryland’s amendment and noting that the defendant had a constitutionally protected right to search for information about abortion.

And in Michigan, a state trial court ruled that a law denying pregnant people the ability to make decisions about their end-of-life care — including preventing them from forgoing life-extending care — infringed on the fundamental right to reproductive freedom codified in the state’s amendment.

These cases are less prominent in legal and popular coverage of post-Dobbs state constitutional litigation over reproductive rights. But they are important examples of the ways that invoking these amendments outside of the abortion context, and in states whose laws are less hostile to reproductive rights, could positively shape judicial understandings of reproductive autonomy, equality, and justice in the years ahead.

Cathren Cohen is a staff attorney with UCLA Law’s Center on Reproductive Health, Law, and Policy.

Suggested Citation: Cathren Cohen, How Are Advocates Using State Reproductive Freedom Amendments?, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (July 23, 2026), https://statecourtreport.org/our-work/analysis-opinion/how-are-advocates-using-state-reproductive-freedom-amendments