The outcome of the case, which will determine what regulations remain in place under Missouri’s voter-approved abortion rights amendment, could influence decisions about abortion law around the country
BY: ANNA SPOERRE
Missouri Independent
A trial litigating the parameters of Missouri’s new reproductive rights amendment begins Monday in Kansas City. The outcome will reach far beyond the state’s borders.
The trial, which will include testimony from abortion providers, Planned Parenthood leadership and anti-abortion doctors, will give an unusually detailed look at the inner-workings of abortion in Missouri, highlighting how just one or two restrictions on the procedure can greatly weaken access in a state where few providers remain.
Over the course of two weeks, the details of Missouri’s numerous abortion regulations will be under a microscope as those in favor of abortion rights argue that nearly every restriction is unconstitutional under the reproductive rights amendment and the state argues the regulations are necessary protections.
The outcome of Missouri’s reproductive rights amendment case — which will either greatly broaden access to abortion in ways not seen in decades, or will hamper access for nearly everyone in Missouri — will reverberate far beyond the Show-Me State, said Rebecca Reingold, an associate director at the O’Neill Institute for National and Global Health Law.
This is particularly true, she said, of states also in the process of litigating abortion access like Arizona, Michigan and Ohio.
“There is little doubt that advocates and decision-makers in other states navigating similar legal challenges are closely monitoring the litigation over Missouri’s abortion regulations,” Reingold said. “ … While state court judges are certainly not bound to follow the decisions of their peers in other states, these decisions can serve as persuasive legal authority, particularly in cases involving novel legal questions or where the relevant legal standards are evolving.”
The result of Missouri’s lawsuit will also greatly affect the landscape of abortion access in the Midwest and the South.
“Missouri also neighbors states with some of the harshest abortion bans in the country,” she said. “That means that the outcome of this litigation will be felt beyond the state’s geographic borders, affecting access to care not only for Missourians, but also people living in neighboring states.”
The case originated with a lawsuit filed by Planned Parenthood and the ACLU of Missouri the day after the November 2024 election in which voters narrowly approved broad abortion access, becoming the first state to overturn a near-total abortion ban through a vote of the people.
Amy Myrick, a senior attorney at the Center for Reproductive Rights, said Missouri is a harbinger for other states attempting to secure abortion protections through constitutional changes.
“Missouri is a test case for what happens when the people have spoken and passed the constitutional amendment with the strongest possible protections, but the state still decides to stand in their way, and the courts have to decide what to do,” she said.
Hypothetically, Myrick said, this should be an open and shut case because Missouri’s reproductive rights amendment was written with some of the strongest protections of any amendment in the country. The amendment prohibits the government from regulating abortion prior to the point of fetal viability unless “such action is justified by a compelling governmental interest achieved by the least restrictive means.”
“So if courts start upholding restrictions against these kinds of protections,” Myrick said. ‘That’s a really bad sign.”
Right now, most of the targeted regulation of abortion provider laws, known as TRAP laws, have been temporarily enjoined — or paused — until a permanent decision could be made at trial.
This includes required distribution of Missouri’s informed consent booklet prior to an abortion; a 72-hour waiting period between an initial appointment and an abortion; and abortion facility licensing requirements. The injunction allowed Planned Parenthood to begin offering in-clinic abortions last February.
Between then and October, 80 in-clinic abortion procedures took place in Missouri across Planned Parenthood clinics in Kansas City, Columbia and St. Louis, according to data from the Missouri Department of Health and Senior Services. In 2023 and 2024, there were no elective abortions performed in Missouri. A few decades ago, prior to the passage of most of Missouri’s abortion restrictions and 2022 ban, thousands of abortions were performed in the state each year. Current data shows several thousand Missourians still accessed abortion in 2024, but had to travel to Kansas or Illinois to do so.
Zhang did not enjoin two regulations that Planned Parenthood says are preventing providers from prescribing medication abortion: a complication plan approved by the state as well as supplemental insurance requirement. For this reason, Missouri doctors remain unable to prescribe the medications mifepristone and misoprostol to patients to end first trimester pregnancies. Medication abortion is the most common method to end a pregnancy in the United States, used in about two-thirds of abortions.
Anti-abortion advocates contend repealing these regulations could put women’s safety at risk.
“Like Michigan and Ohio before them, the amendment was the first step, opening the door for the abortion lobby to tear down all of the health and safety standards for women’s protections that the Missouri legislature required over the years,” said Katie Glenn Daniel, director of legal affairs and policy counsel at SBA Pro-Life America.
Myrick said attempts to tie regulations to health and safety claims are nothing new.
“Every single one of these restrictions is about hostility to abortion, making it harder to access abortion,” she said. “Even something like a complication plan can be a shutdown law if it’s impossible to comply with. So there’s no way this is about health or safety.”
She said Missouri anti-abortion leaders have long been creative, spearheading many of the national fights against mifepristone in particular.
In November, Missouri Attorney General Catherine Hanaway sued over the latest approval of a generic version of mifepristone, asking the federal government to overturn the approval and to reinstate in-person dispensing laws for the medication, which can currently be prescribed in some states during telehealth appointments and then mailed to patients.
Last summer, Hanaway’s predecessor, Andrew Bailey, sued Planned Parenthood over its claims that mifepristone is safer to take than over-the-counter medications like Tylenol, penicillin and Viagra.
And Missouri is now the lead plaintiff in a federal lawsuit seeking to limit the availability of medication abortion. The case originated in Texas and moved all the way up to the United States Supreme Court before the nation’s highest court said the original plaintiffs didn’t have the jurisdiction to sue.
Sarah Wetter, senior associate with the O’Neill Institute at Georgetown Law, said the transfer of the federal case to Missouri makes the state litigation beginning Monday “all the more threatening” as the Missouri Attorney General’s Office also prepares to argue against mifepristone at the federal courthouse in St. Louis.
“Turning back the clock to pre-2016 rules would limit mifepristone access to patients up to 7 (rather than 10) weeks gestation, require more in-person visits, and otherwise prohibit telemedicine abortion,” Wetter said.
Many high-ranking Missouri politicians have shown repeatedly that abortion remains among their highest priorities, with few saying they’ll back down if the abortion rights amendment is fully implemented following the trial. A prime example of this is the Republican supermajority’s success in putting a proposed abortion ban on this year’s November ballot. Plans are already underway to continue attempting to limit access to the procedure, whether the abortion ban amendment passes or fails later this year.
Politics are supposed to be left out of the courtroom, said Michael Wolff, a former chief justice of the Missouri Supreme Court and dean emeritus at the St. Louis University School of Law. He’s curious if that will be the case next week.
“The courts, in my experience in Missouri, have always been solicitous of what the voters were voting on,” he said.
Wolff, who advised in the drafting of the abortion rights amendment, said any arguments by the state that abortion regulations are necessary because Missouri voters didn’t realize the scope of what they were voting on should be heeded cautiously.
“Haven’t these political issues, these questions about the desirability of this law, already been litigated when they had to campaign where the voters approved (abortion)?” Wolff said. “ … It’s not a matter for the courts to decide whether the voters were dumb or or smart when they did this.”