Missouri Appeals Court Upholds Order Blocking Abortion Restrictions 

The battle to determine the real-world impact of Missouri’s reproductive-rights amendment reached a pivotal point last week when an appellate court affirmed a decision blocking the enforcement of several laws restricting abortion. The ruling is significant because it suggests that efforts to hollow out reproductive-rights ballot measures might be turned away, even in conservative states.

After the U.S. Supreme Court overruled Roe v. Wade in 2022, Missouri enacted one of the harshest abortion bans in the nation. But in 2024, Missouri voters passed the Right to Reproductive Freedom Initiative, which created a new state constitutional reproductive right. Planned Parenthood then filed a wave of challenges to the state’s abortion ban and restrictions, arguing that they violated the state’s new reproductive freedom amendment. The suits aimed to clear up confusion about the state of the law and make it possible for providers across the state to offer a fuller range of services.

Last week’s decision in Comprehensive Health of Planned Parenthood Great Plains v. Missouri, Comprehensive Health concerned Planned Parenthood’s challenge to targeted regulations of abortion providers, known as TRAP laws. The measures at issue include 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 is performed. Planned Parenthood argued that these measures were unconstitutional under the new amendment and sought an injunction blocking their enforcement while the litigation continued.

In a series of rulings late last year and early this year, Missouri trial Judge Jerri Zhang granted Planned Parenthood’s request, reasoning that the regulations neither served a compelling government interest nor used the least restrictive means of achieving the government’s goal. The reproductive-rights amendment made clear, she explained, that the government had a compelling interest only if it acted “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 the amendment because they singled out abortion for especially onerous regulation.

The state then sought a special order directly from the state supreme court called a writ of mandamus to allow the state to continue enforcing the TRAP laws. The supreme court granted the attorney general’s request, explaining that Zhang had applied the wrong standard for evaluating whether to grant a preliminary injunction against the laws: Rather than require Planned Parenthood to show that it was likely to prevail on the merits, Zhang had considered whether the plaintiff had a fair chance of prevailing. The state supreme court directed Zhang to reconsider, under the new standard, whether to gran the injunction. In July, applying the correct standard, Zhang again enjoined enforcement of the challenged restrictions.

This week’s ruling unanimously upheld Zhang’s July decision. The court began by disposing of the state’s procedural arguments, including those addressing whether Planned Parenthood had standing to sue. Planned Parenthood obviously faced jeopardy under the state’s restrictions, the court reasoned, since all of them “impose a criminal punishment on the abortion provider for violating them.” What was more, Planned Parenthood had standing to argue Missouri’s regulations discriminated against abortion providers as compared to other medical providers, in violation of the abortion rights amendment. The court also rejected the state’s argument that there was no live controversy for the court to resolve — a requirement for standing — because the state had vowed not to enforce some of the challenged provisions during the course of Planned Parenthood’s suit. A dispute remained even as to those disavowed provisions, the court said, because Planned Parenthood argued those restrictions had no constitutional application, while the attorney general maintained there were certain circumstances under which they still could be enforceable.

The court next turned to whether Zhang had abused her discretion when she granted Planned Parenthood’s request for an injunction. There was no evidence for the state’s argument that the abortion-rights amendment “only restricts statutes and regulations which directly bar or restrict abortion access,” the court said. Rather, it applied to “all statutes and regulations which have the effect of interfering with or restricting access to abortion.”

Moreover, the court noted, the amendment also prohibited discrimination against abortion providers and services. Because the challenged regulations applied only to abortion and not to comparable surgical procedures, the court explained, the burden shifted to the state to prove that the law could have constitutional applications. The appellate court agreed with Zhang that the state had not shown at this juncture that it could carry its burden and that Zhang, therefore, did not abuse her discretion in concluding that the challenged restrictions were likely unconstitutional.

Finally, the court rejected the state’s claim that Planned Parenthood could not demonstrate that enforcement of the challenged restrictions during the litigation would cause irreparable harm, another requirement for winning a preliminary injunction. The state urged that patients could travel to providers in other states to receive abortion services — an argument the court called “disingenuous.” Missourians adopted the abortion-rights amendment “so that Missouri residents would not have to travel to a different state to receive abortion care,” the court said.

But the fight is far from over, as a full trial on the constitutionality of the TRAP laws is set for January 2026. Planned Parenthood and the American Civil Liberties Union (ACLU) are also pursuing a separate challenge to state regulations that they say stop providers from offering mifepristone and misoprostol, drugs used in the majority of abortions nationwide. These cases are likely to eventually make their way to the Missouri Supreme Court.

Then there is the matter of whether the state’s constitution will change again. The state’s Republican-majority legislature has proposed a new ballot measure for voters to consider in 2026 that would reverse the result voters achieved in 2024 and criminalize abortion in all but a handful of circumstances. The ACLU challenged the wording of the proposal as inaccurate and biased because it did not put voters on notice that, should it pass, abortion in the state would once again be made a crime. After several failed attempts, a trial judge approved the state’s most recent proposed language, which mentions the repeal of “Article I, Section 36” — a reference to the reproductive rights amendment — without including its descriptive name or stating that abortion would be banned in almost every circumstance.

Abortion restrictions likely won’t stand if last year’s amendment remains on the books. Missouri anti-choice lawmakers seem to think the best way to limit access to reproductive healthcare is to undo voters’ decision to protect abortion access — by obscuring the true consequences of next year’s anti-abortion ballot measure.

Mary Ziegler is Martin Luther King Jr. Professor of Law at the University of California Davis School of Law and the author of Personhood: The New Civil War Over Reproduction.

Suggested Citation: Mary Ziegler, Missouri Appeals Court Upholds Order Blocking Abortion Restrictions, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ(Oct. 20, 2025), https://statecourtreport.org/our-work/analysis-opinion/missouri-appeals-court-upholds-order-blocking-abortion-restrictions