Both sides of the abortion debate seemed caught by surprise last week by the Missouri Supreme Court's order that essentially reimposed the state's abortion ban.
Planned Parenthood clinics were sent scrambling, cancelling abortion appointments and working with patients to ensure access in other states — a return to the way things operated before voters enshrined reproductive rights in the state constitution last year.
Anti-abortion advocates, meanwhile, celebrated the return of regulations but acknowledged the win could be temporary.
With no clear indication of when — or if — access to abortion will be restored, and a GOP-crafted amendment banning the procedure heading for the ballot next year, advocates on both sides are navigating the uncertainty and gearing up for the fight ahead.
"…anti-abortion politicians in Jeff City have once again weaponized our political system against Missourians. What's really clear here is the confusion this will cause among patients was the whole point," said Mallory Schwarz, executive director of Abortion Action Missouri, later adding: "Missourians proved at the ballot box that what we want is access to abortion. This is not over, and I'm confident that ultimately abortion care will continue in Missouri."
Sam Lee, a longtime anti-abortion advocate with Campaign Life Missouri, expressed relief that state regulations are back in place but cautioned that the only way to "safeguard the lives of unborn children" is to amend the constitution next year.
"While it is good news that abortion has ended in Missouri – at least for now – it would be a mistake for the pro-life movement to rely on the state courts to keep these health and safety laws and regulations in place," he said.
While the court last week imposed what abortion providers called a "de facto ban," it didn't actually weigh in on the constitutionality of state regulations. The decision was procedural, calling into question the legal standard a Jackson County judge used to justify blocking certain abortion regulations enacted over the years by state lawmakers.
The injunction was vacated and the judge was ordered to re-evaluate the case using the standards the Supreme Court laid out last week. A new injunction could be issued, or access could be left in limbo while the case makes its way to a January 2026 trial.
Fifty-two percent of Missouri voters in November approved Amendment 3, which said "the right to reproductive freedom shall not be denied, interfered with, delayed or otherwise restricted unless the government demonstrates that such action is justifiable by a compelling governmental interest achieved by the least restrictive means."
The amendment made Missouri's abortion ban unconstitutional, at least until the point of fetal viability, which is generally considered at or around 24 weeks.
Attorney General Andrew Bailey acknowledges this in his appeal to the Supreme Court, writing that among the laws which are no longer enforceable because of Amendment 3 are "Missouri's prohibitions on abortion before viability."
But myriad other restrictions remained on the books, including wait times before abortions and constraints on where abortions could be performed.
Planned Parenthood affiliates in Missouri sued in December to overturn the state's Targeted Restrictions on Abortion Providers, or TRAP laws. Over the course of a decade before an outright ban on abortion was put in place, those laws resulted in the number of abortions performed in Missouri falling from more than 5,000 to less than 200.
Over the course of two rulings — one in December and one in February — Jackson County Judge Jerri Zhang pointed to the voter-approved constitutional amendment in issuing the temporary injunction.
Most notably, Zhang struck down licensing requirements for abortion clinics, arguing the regulations were "unnecessary" and "discriminatory" because they do not treat services provided in abortion facilities the same as other types of similarly situated health care, including miscarriage care.
She left in place a requirement that all abortion providers have a medical license.
Zhang's ruling opened the door for procedural abortions to resume in Planned Parenthood's Kansas City and Columbia clinics. Medication abortions, which nationally make up two-thirds of all abortions, have not been available as the clinics have been unable to get the state to approve a required complication plan.
The state Supreme Court order, signed by Chief Justice Mary Russell, means even procedural abortions are now inaccessible in Missouri.
"This is not the end of the legal battle, but it is a critical victory for every pro-life Missourian," said Brian Westbrook, executive director of Coalition Life.
Abortion may be inaccessible in Missouri, but "the good news is that this court ruling does not affect other reproductive and sexual health care provided at Planned Parenthood health centers across the state," said Dr. Margaret Baum, chief medical officer for Planned Parenthood Great Rivers.
The hope, Baum said, is that the court's order is only a "temporary setback." In the meantime, she said access to abortion is still available in Kansas and Illinois and that Planned Parenthood will support patients "who need lodging, transportation and other resources to access sexual and reproductive health care, including abortion."
This story was originally published by the Missouri Independent.
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