The Fight for One of the Year’s Biggest Abortion-Rights Votes

When Ashley Jaworski became pregnant shortly after Dobbs, she and her doctor discussed whether she’d have to cross state lines to get an abortion due to her history of ectopic pregnancy. Her physician worried that, under Missouri’s near-total abortion ban, Jaworski wouldn’t be able to obtain the care she needed if that happened again. “I was so sad and angry,” she says. “I should not have to leave for this everyday medical care.” While that pregnancy ended in a healthy birth, Jaworski remains acutely aware that other patients and their families have not been so lucky. “Missouri is a state where all different kinds of people are being held hostage by anti-abortion extremists in Jefferson City,” she says, “who are writing laws that are out of touch with what people want.”

Thanks to a Tuesday decision from the Missouri Supreme Court, Jaworski and others like her will have the opportunity to lift those restrictions on November 5: The state is officially one of 10 where abortion rights will be on the ballot. Jaworski, a native Missourian, is one of hundreds of volunteers who have been campaigning for Amendment 3, which would codify the right to “reproductive freedom” in the state’s constitution. She says the process of collecting signatures to put the measure on the ballot earlier this year showed Missourians what they have in common with their neighbors: “We want bodily autonomy; we want these rights.”

Currently, Missouri’s ban permits abortions only in limited cases of medical emergencies. Health providers, afraid of being charged with a felony, have turned away patients anyway, and legislators have refused to add exceptions for cases of rape and incest despite calls to amend the law. Amendment 3 would protect a range of reproductive health care, including pregnancy care and access to contraception, and would restore abortion access in the state.

Missouri was the first state to outlaw abortion, which it did within minutes of the Supreme Court overturning Roe v. Wade, and if supporters of the ballot measure are successful, it may also be the first state to reverse a post-Dobbs near-total ban. “This amendment is not earth-shattering. It is really just putting health care back where it belongs,” says Dr. Jennifer Smith, an OB/GYN in St. Louis who is campaigning for the measure. “In every other aspect of health care, we have these conversations with patients and make these decisions without government interference. All we’re asking is to have women in our state have that same basic freedom.”

The coalition behind the amendment, Missourians for Constitutional Freedom, announced in May that it had collected more than 380,000 signatures in the span of three months, which was twice the total needed to qualify for the ballot. The coalition is led by the grassroots organization Abortion Action Missouri, the ACLU of Missouri, and the state’s Planned Parenthood affiliates. Its partners include a statewide network of health-care professionals, several religious organizations, and The Fairness Project, which has supported many of the pro-choice ballot measures since Dobbs. Rachel Sweet, who successfully led abortion-rights fights in Kansas and Kentucky in 2022, serves as campaign manager.

But the road to getting Amendment 3 before voters has been filled with obstacles. In April 2023, the Republican state auditor crafted a fiscal summary saying Amendment 3 would have no cost to the state government if approved. Missouri attorney general Andrew Bailey refused to sign off on the summary, instead attempting to mislead voters. In July 2023, the state Supreme Court struck down his effort and said he should certify the fiscal note. Then, in August 2023, GOP lawmakers sued over the cost estimate; the lawsuit was eventually dropped.

Missouri secretary of state Jay Ashcroft, who opposes abortion, then crafted the ballot’s summary language to falsely say it would allow for abortion care throughout pregnancy and that it would prohibit criminal or civil penalties that could protect patients. A judge later ruled that Ashcroft’s language was “unfair, insufficient, inaccurate, and misleading,” writing a new summary to appear on the ballot.

Ashcroft’s language echoed anti-abortion advocates’s furious misinformation campaign to convince voters that Amendment 3 goes much farther than Roe (it doesn’t, as the measure would allow abortions up until viability); that it’d eliminate parental consent laws (a false anti-trans talking point that Republicans also tried to employ to defeat Michigan’s and Ohio’s recent ballot measures); and that it’d ultimately hurt the health and safety of women in the state, when in reality the amendment strengthens protections for all sorts of reproductive health care.

Amendment 3’s opponents launched their last-ditch effort to remove it from the ballot in August. The right-wing law firm Thomas Moore Society sued Ashcroft, saying that he had wrongly certified Amendment 3 to appear on the ballot this election. On September 6, Cole County Circuit Judge Christopher Limbaugh — cousin of the late Rush Limbaugh — ruled in favor of the anti-abortion plaintiffs and argued that the text of the measure violated state law because it did not not adequately list which legislation it would repeal if it passed. Missourians for Constitutional Freedom went straight to the Missouri Supreme Court with an emergency appeal, while Ashcroft decertified the measure without waiting for the court’s decision.

On Tuesday, just a few hours before a deadline to make changes to November’s ballot, the initiative cleared its final legal hurdle. The state Supreme Court overturned Limbaugh’s decision, ruling that Amendment 3 must appear on the ballot.

“The anti-abortion side has thrown every wrench they could into the process,” says Mallory Schwarz, a spokesperson for the campaign. “The state challenged our language. They tried at every step to manipulate and mislead Missourians about what this amendment really is. They lied about the cost. They crafted deceitful and manipulative summary language, which is what voters actually see on the ballot.”

Recent polling shows that around 52 percent of Missourians support the measure, up from 44 percent in February, with 34 percent opposing it and 14 percent saying they are unsure. Jaworski says people from all political backgrounds have shared their experiences with reproductive health care, whether it’s abortion or something else, with her while canvassing.

“Even folks who perhaps would never choose an abortion for themselves, they don’t want the government making this choice for other people. And they see the direct connection between abortion rights and IVF and birth control,” she says. “I spoke to a woman who is a devout, lifelong Catholic and who adopted a daughter when she couldn’t conceive. Before adoption, she tried IVF. She told me, ‘I know that they’re gonna come for IVF next and that is wrong. So I am going to vote for this. I never thought I would be siding with pro-choice people, but I am with you.’”

The coalition’s goal over the next 55 days is to maintain momentum. That’s an expensive undertaking: Michigan’s campaign to codify abortion rights in 2022 had a $68 million price tag, while Ohio’s ballot measure last year cost around $50 million. In the lead-up to November, Schwarz says every donation is crucial because it means reaching more voters and ensuring they’ll turn out to vote. Missourians for Constitutional Freedom is still recruiting volunteers to canvas across the state and conduct virtual phone-banks.

The push to codify abortion rights would curb the harm caused by the state’s abortion ban: Schwarz pointed to a recent study showing that women in Missouri face more limited access to health care than in any other state in the Midwest, as well as worse health outcomes than other female patients in the region. The state has seen a 25 percent drop in applications for OB/GYN medical residencies, which will likely translate into fewer physicians being able to provide comprehensive reproductive health care to Missourians.

And even before Dobbs, years of relentless anti-abortion legislation in Missouri had whittled down abortion care to a single clinic for a state where about 1.2 million women of reproductive age reside. Abortion seekers typically went to Kansas and Illinois instead, but those states have been overwhelmed in recent years trying to serve patients from across the Midwest and the South. If Missouri restores abortion rights, it could absorb some of that need.

It’s not only the physical health of pregnant people at stake. Smith, the OB/GYN, said that the current restrictions have taken a psychic toll on both patients and other providers in her practice. “Patients who are aware of the law — and there’s certainly a lot of people who just don’t realize — are really fearful of being pregnant in Missouri and what will happen if something goes wrong,” she says. “I also think, Will I be able to care for them? We all want to be able to provide patients the full spectrum of care and not have to worry that we’ll be stopped because of fear of breaking the law.”

As with all the pro-choice ballot measures that have passed since Dobbs, access to abortion wouldn’t be restored in Missouri overnight. According to Schwarz, the campaign expects the state’s anti-abortion lawmakers to put up a fight. They could follow the lead of Republican legislators in Ohio, who last year tried to strip judges of their power to interpret an amendment enshrining reproductive rights in the state constitution and fought in court to maintain anti-abortion restrictions. But Schwarz is hopeful that if Amendment 3 passes, Missouri courts will throw out those efforts — just like in Ohio.

“This is the first step,” Schwarz says. “The fight won’t stop here, but it’s the most powerful position we could be in. It’ll give us the strongest tool we have to ensure that we can restore and rebuild abortion access for Missouri.”

The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.