Missouri voters will decide whether to legalize abortion in November

Abortion will be on Missouri’s statewide ballot in November.

An initiative petition to enshrine the right to abortion up until the point of fetal viability received final approval Tuesday, securing a place on the general election ballot. If the measure receives a majority of votes, Missouri could become the first state to overturn an abortion ban through a citizen-led measure.

The Missouri Secretary of State’s Office had until 5 p.m. to certify all ballot measures that received enough verified signatures to qualify. It certified the measures as sufficient hours before that deadline. Also certified to be on the November ballot were proposals to legalize sports wagering and raise the minimum wage.

Leaders with Missourians for Constitutional Freedom, the coalition behind the ballot measure, gathered at a press conference Tuesday to encourage Missourians to get out to vote. The coalition is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates.

“Politicians have tied doctors’ hands and the stakes could not be higher,” said Mallory Schwarz, executive director of Abortion Action Missouri. “ … With a yes vote on amendment 3 this November, we are taking back what’s ours.”

In Missouri, the first state to ban abortion after the U.S. Supreme Court overturned the constitutional right to the procedure two years ago, abortion is expected to be a focal point of the general election campaign.

Missouri is among 18 states with an abortion ban, and among several states working to put abortion on the ballot. In each state that put the issue on the ballot, citizens ultimately choose to protect the procedure.

“The measure takes away the right from every person who loses a child or a loved one because of negligence during pregnancy, labor or delivery the freedom to sue for malpractice and obtain compensation,” Stephanie Bell, a spokeswoman with Missouri Stands with Women, said in a statement Tuesday.

Tori Schafer, director for policy and campaigns for the ACLU of Missouri, responded to the comment, saying the statement is “fully false” and that the amendment doesn’t impact malpractice laws already in place.

What would the amendment do?

Abortion is illegal in Missouri, with limited exceptions only in cases of medical emergencies. There are no exceptions for survivors of rape or incest.

If the amendment receives more than 50% of votes in approval, the measure would legalize abortion up until the point of fetal viability, an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists.

Such an amendment would return Missouri to the standard of the 1973 Roe v. Wade decision, which also legalized abortion up to the point of fetal viability. Missouri’s amendment also includes exceptions after viability “to protect the life or physical or mental health of the pregnant person.”

Missouri’s amendment also states that women and those performing or assisting in abortions cannot be prosecuted. Under current Missouri law, doctors who perform abortions deemed unnecessary can be charged with a class B felony and face up to 15 years in prison. Their medical license can also be suspended or revoked.

Dr. Selina Sandoval, associate medical director for Planned Parenthood Great Plains Votes, said the right to make decisions about abortion is personal and she sees each day the barriers and hardships bans cause.

“In Kansas right now, we are serving mostly out-of-state patients, including Missourians, who’ve had to flee their home states in order to simply access abortion care,” Sandoval said Tuesday.

Missourians for Constitutional Freedom, the coalition leading the reproductive-rights campaigns, is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates.

A decade ago, when abortion was still legal with fewer limitations, more than 5,000 abortions were performed in the state, according to data from the Missouri Department of Health and Senior Services. But by 2020, that number dropped to 167 due to a series of “targeted regulation of abortion providers” laws passed, including a mandatory 72-hour waiting period between the initial appointment and a surgical abortion and mandatory pelvic exams for medication abortions.

Since the Supreme Court decision in June 2022 through March 2024, there were 64 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services.

A recent study by the Guttmacher Institute, a reproductive rights research group, showed that in 2023 alone, 8,710 Missourians traveled to Illinois and 2,860 Missourians went to Kansas for the procedure, which remains legal in both states.

Despite the relative proximity to clinics in the Illinois suburbs of St. Louis and the Kansas suburbs of Kansas City, abortion access for Missourians has remained precarious at best.

Missourians hoping for abortions have increasingly found themselves competing for limited resources — including abortion funds and clinic appointment openings — especially as more southern states have outlawed the procedure, making Illinois and Kansas critical access points for women in states like Florida, Oklahoma and Texas.

This has led many Missourians to increasingly rely on self-managed medication abortions. Rather than traveling across state lines, it’s estimated that thousands of Missourians received Mifepristone and Misoprostol to end their pregnancies at home in the past two years according to JAMA, the American Medical Association’s journal.

On Tuesday, members of Missourians for Constitutional Freedom continued to return to their continued fears for women’s health care in Missouri if a ban remains in place. Missouri already has stark maternal health care deserts, high maternal mortality rates, and recently saw a decrease in applicants to OB-GYN residency programs.

Schafer, with the ACLU, said the coalition plans to start rebuilding access to abortion on day one, if the measure passes.

“We know that after passage, constitutional amendments take 30 days to go into effect in the state of Missouri,” she said. “And we are hopeful that clinics will be open and our teams will be working toward that as our goal.”

Schwarz said they’ve been in contact with abortion providers about coming back to Missouri.

“After we win this in November, the impact will be regional and across the country,” she said. “And and from abortion providers that we are in close regular relationship and contact with, people are thinking all the time about where the next clinic can be, where the next opportunity is for them to grow and be able to support more and more patients.”

Wide support despite initial delays

The initial attempt to place abortion on the ballot began in March 2023.

Legal fights with Republican state officials over the ballot language and internal disagreements on whether to include a viability ban stalled signature gathering attempts until January.

As a result, the coalition had just 90 days to fundraise and collect signatures across the state.

Meanwhile, Republican lawmakers were prioritizing an attempt to raise the threshold for approving citizen-led ballot measures. After a series of Senate filibusters, including one that broke records at 41 hours, the legislation failed on the final day of session.

Missouri House Speaker Dean Plocher on the day of adjournment said that if abortion made it to the ballot and then passed in November under the current initiative petition guidelines, “the burden of abortion falls squarely on the Senate and its leadership.”

Despite these obstacles, the initiative petition garnered wide support across the state.

As of July, the campaign raised nearly $7.3 million in donations, according to filings with the Missouri Ethics Commission.

Missourians for Constitutional Freedom turned in 380,000 signatures by their May deadline, including from each of Missouri’s 114 counties. To qualify for the ballot, they had to get signatures from 8% of registered voters in six of Missouri’s eight congressional districts, which equates to about 171,000 signatures.

As of mid-July, the campaign had turned in more than enough valid signatures to land on the ballot, according to preliminary records from Missouri election authorities.

Once all verified signatures were turned in by election authorities in late July, the secretary of state’s office had two weeks to determine whether there were any final issues, like duplicate pages or missing affidavits signed by circulators.

On Tuesday, the secretary of state’s office also certified ballot measures hoping to raise the state’s minimum wage and mandate paid sick leave and legalize sports wagering. A third proposal to authorize construction of a new casino near Lake of the Ozarks fell short of the needed signatures.