Abortion clinics in the staunchly Republican state of Missouri this week resumed procedures for the first time in years, despite a continued push by conservative state leaders to block a constitutional amendment enshrining abortion rights that voters approved in November.
It was a remarkable moment after an extended fight. Missouri was the first state to enact an abortion ban after the Supreme Court overturned Roe v. Wade in 2022. Then in 2024, it became the first state with a near-total ban to approve a citizen-sponsored abortion rights amendment.
On the day after voters approved the constitutional amendment, abortion rights groups sued to overturn the ban as well as a host of other restrictions on abortion that preceded the ban. Planned Parenthood, the only provider of abortions outside of hospitals in the state, resumed abortion procedures after a judge on Friday granted a temporary injunction that blocked state licensing requirements imposed on clinics. The clinics had said that the requirements made it impossible to operate.
Planned Parenthood still will not provide abortion pills until the state approves a required plan for reporting any complications faced by women who use them. And Republican legislators are still pressing for a raft of bills that would restrict or reverse the amendment passed in November.
The struggle to provide abortions three months after the ballot measure passed highlights the difficulties that clinics face despite popular support for abortion rights among voters.
Still, Emily Wales, the president of Planned Parenthood Great Plains, said that relative to other states with bans, Missouri was moving at “breakneck speed.”
“It feels like a long time for Missourians,” she said, “and every single day that there are people in the state who have to leave for abortion access, their rights are being violated.”
“At the same time,” she added, “constitutional change is huge. We didn’t know we could even take on this fight, or that we’d be successful, or that we’d get beyond all the barriers to be on the ballot a year ago.”
Stephanie Bell, a spokeswoman for Missouri Stands with Women, one of the groups that opposed the ballot measure in November, criticized the judge for allowing “unlicensed and unregulated abortion clinics prioritizing profits over safety.”
“No woman should suffer, and no innocent life should be taken, in the name of an industry that refuses to be held accountable,” she said.
The amendment, approved by nearly 52 percent of Missouri voters, established a constitutional right to abortion until viability, the point in pregnancy when doctors generally believe a fetus can survive outside the uterus without extraordinary medical interventions.
Judge Jerri Zhang of Jackson County Circuit Court, which includes Kansas City, issued an earlier injunction in December, two weeks after the amendment took effect, that invalidated the near-total ban and blocked some abortion restrictions. Those restrictions included a requirement that patients wait 72 hours between an initial consultation with the provider and receiving an abortion, and another requirement that patients see the same doctor for both appointments.
That ruling allowed hospitals to offer abortions, including for miscarriage care, without the threat of criminal penalties. But Planned Parenthood postponed plans to resume abortion services because the judge declined to overturn the licensing requirements.
To get a license, clinics had to abide by a list of rules that included minimum sizes for hallways, rooms and doors, extensive reporting requirements and mandatory pelvic exams for patients seeking abortion pills, contradicting standard medical practice.
The requirements were so onerous that most clinics stopped providing abortions long before the Supreme Court overturned the right to an abortion; state reports show that there were 167 abortions in Missouri in 2020, down from about 5,000 a decade before, even as abortion remained legal.
In her ruling late Friday, Judge Zhang said the licensing requirement was discriminatory, “because it does not treat services provided in abortion facilities the same as other types of similarly situated health care, including miscarriage care.”
Planned Parenthood had noted that Missouri did not require the same licensing for clinics that offer vasectomies, cataract removals, liposuction and other surgeries, including those that involve general anesthesia. Nor did it have the same requirements for private physicians who do miscarriage management using the same medicines and procedures that abortion clinics use.
Attorney General Andrew Bailey of Missouri, a Republican who opposes abortion rights, is expected to appeal the judge’s ruling; a spokeswoman did not return requests for comment.
Republicans who control the legislature have filed more than two dozen bills proposing limits to the amendment voters approved in November, including some that would ask voters to approve a contradictory amendment banning abortion in all or most cases.
Abortion Action Missouri, which supported the abortion rights amendment in November, announced that it would expand its clinic escorts program. A group that opposed the ballot measure, Coalition Life, said it would resume protests and sidewalk counseling outside the Planned Parenthood clinic in St. Louis.
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