Lawsuit challenges Missouri's abortion restrictions hours after voters approve Amendment 3

Missouri’s Planned Parenthood clinics filed a lawsuit Wednesday seeking to strike down the state’s current abortion restrictions, less than 24 hours after an amendment enshrining reproductive rights in the constitution was approved by voters.

The news was announced Wednesday afternoon by coalition members of Missourians for Constitutional Freedom, the organization behind Amendment 3.

Leaders with both Planned Parenthood Great Plains and Planned Parenthood Great Rivers said if the court grants their injunction, they plan to start providing abortions the day the amendment goes into effect Dec. 5 at the health centers in Columbia, the Central West End in St. Louis and the Midtown neighborhood of Kansas City.

“The restrictions we’re challenging today do not actually help patients. They hurt them,” Richard Muniz, interim president and CEO of Planned Parenthood Great Rivers, said during a news conference Wednesday. “The ripple effects of these overreaching policies can be felt throughout the state. Missouri continues to have high STI rates and poor pregnancy outcomes, and providers do not want to train or practice in Missouri, creating even further scarcity and gaps in coverage for thousands of women and pregnant people throughout Missouri.”

The constitutional amendment, which won with 51.7% of the nearly 3 million votes cast Tuesday, goes into effect in 30 days and prohibits the legislature from regulating abortion prior to the point of fetal viability — generally seen as the point at which a fetus can likely survive outside the womb without extraordinary measures.

But both proponents of and those opposed to Amendment 3 have warned that abortion access would not be immediate, as a bevy of challenges to current law must first make their way through the courts.

The lawsuit, which was filed in Jackson County, challenges several current state laws, including the state’s current abortion ban, a trigger law enacted in June 2022 that only allows abortions exceptions in cases of medical emergencies.

Among the TRAP laws targeted by the new lawsuit:

• Requirements that abortion clinics be licensed as ambulatory surgical centers.
• A 72-hour waiting period between a patient’s initial visit with a doctor and their abortion procedure.
• Mandates that abortion clinics be located within 30 miles of a hospital where they have admitting privileges.
• The required submission of all tissue removed during an abortion be submitted to a pathologist.
• Rules requiring abortion providers report all abortions and abortion complications to the state.
• Requirements that the same physician who initially sees a patient must also be the physician who performs the abortion procedure.
• Current law requiring only physicians can perform abortions, excluding physician assistants and advanced practice registered nurses.

The lawsuit also addresses access to medication abortion, asking that a judge lift the current restrictions that would make it difficult to prescribe, including a telemedicine ban that requires the physician who prescribes the medication to also be in the room when the patient takes the first dose of the medication.

It also seeks to end criminal penalties for abortion providers, who currently face loss of their license and up to 15 years in prison if they perform an abortion that doesn’t fall under the current exception for medical emergencies.

The lawsuit does not challenge Missouri’s current law requiring parental or guardian consent for minors seeking abortions. Muniz did not specifically say whether this will be challenged in the future, but rather noted this is only the first lawsuit.

Court challenges can take months, if not years. In Ohio, where citizens voted to protect abortion rights one year ago, a county judge just struck down that state’s “heartbeat” law.

Freda Levenson, legal director for the ACLU of Ohio, said while the payoff is worthwhile, the road can be long to reach widespread access.

“They shouldn’t engage in magical thinking or fiction that these restrictions will fall away on their own,” she advised Missourians who voted in support of Amendment 3. “This is going to take hard work.”

Tori Schafer, director of policy and campaigns at the ACLU of Missouri, said while she hopes the Legislature will respect the will of the people, those who supported Amendment 3 stand ready to hold them accountable.

Missouri lawmakers including state Sen. Mary Elizabeth Coleman and U.S. Sen. Josh Hawley have said they intend to give Missourians the opportunity to vote on abortion again.

When asked in September what GOP lawmakers might do if Amendment 3 passed, Coleman pointed to a 2018 citizen-led amendment that would have required legislative districts be drawn to ensure partisan fairness. This amendment, known as “Clean Missouri”, was repealed two years later through a Legislature-proposed amendment.

On Wednesday morning, Mary Catherine Martin, an attorney with the Thomas More Society who previously argued against the amendment before the Missouri Supreme Court, promised to defend Missouri against Amendment 3.

“They’re not going to stand back and give up,” Levenson said. “They’ll fight around the edges to keep any restrictions in that they can.”

Former President Donald Trump’s victory means Missouri abortion-rights organizations may have more than just state anti-abortion forces working against them. It could soon also be the federal government.

One example is federal enforcement of the Comstock Act, an 1873 law that bans mailing obscene material, including for the use of abortion.

Hawley, who was reelected to a second term Tuesday, was among several senators who signed a letter in 2023 asking the U.S. attorney general to enforce the Comstock Act and make illegal the mailing of abortion medication, which has increasingly become popular and accessible across the United States over the last two years.

“We are being thoughtful about what a change in the federal administration could mean,” said Emily Wales, president and CEO of Planned Parenthood Great Plains. “I think more than anything, it will be the time for Missourians and individuals in other states who may have crossed political lines to hold accountable national leaders who have said they think this should be an issue decided by the states.”

Kellie Copeland, executive director of Pro-Choice Ohio, which led that state’s successful abortion-rights ballot measure last year, noted that it also takes time to rebuild health care infrastructure that had been limited or eliminated with abortion restrictions.

While abortion wasn’t outlawed in Missouri until the U.S. Supreme Court overturned the constitutional right to an abortion two years ago, Missourians have long lacked access to the procedure as TRAP laws whittled away at abortion clinics’ abilities to stay open.

For clinics near the Kansas and Illinois borders, providers began sending Missourians across state lines where laws were less restrictive.

A decade ago, more than 5,000 abortions were performed in Missouri, according to the health department. By 2020, that number dropped to 167 because of a series of “targeted regulation of abortion providers” laws enacted by the Legislature, including a mandatory 72-hour waiting period between the initial appointment and a surgical abortion and mandatory pelvic exams for medication abortions.

Between June 24, 2022, and July 31, 2024, 74 abortions were performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services.

Despite facing additional hurdles to care, including the time and financial costs of travel, time off work and child care, many Missourians have continued accessing abortion in the post-Roe era.

In 2023 alone, approximately 2,860 Missourians traveled to Kansas for abortions, and 8,710 traveled to Illinois, according to the Guttmacher Institute, a reproductive rights research group that closely tracks abortion data.

Abortion access in Missouri will likely have ripple effects across the Midwest and south, opening up another access point for those in states with bans like Iowa, Arkansas, Oklahoma and Texas.

Copeland said Missouri’s first step toward legal action is nothing short of “momentous”.

“That the Missouri team did it this year of all years in this political climate is astounding,” she said. “It shows what an incredible campaign they waged, but also how deeply people feel about abortion access and reproductive freedom regardless of the party they identify with.”