A ballot initiative to enshrine reproductive rights in
the state constitution has a groundswell of support. Its
success hinges on turnout.
It was a mild, crisp, and sunny Saturday afternoon, and
the two doctors were on a mission. Flyers and stickers in
hand, they made their way through the Columbus Square
Park neighborhood of Kansas City, Missouri, which sits
just blocks south of the winding and muddy Missouri
River.
Iman Alsaden and Selina Sandoval, respectively the chief
medical director and associate medical director of
Planned Parenthood Great Plains, were among the 50 or so
volunteers spread out across Kansas City on October 26 as
part of a coordinated get-out-the-vote effort in support
of the state’s proposed Amendment 3. The measure seeks to
undo Missouri’s total abortion ban that took effect less
than an hour after the U.S. Supreme Court issued its
Dobbs v. Jackson Women’s Health Organization decision in
June 2022. With just 10 days to go until Election Day,
similar efforts were also underway in St. Louis and
Columbia, home to the University of Missouri’s flagship
campus.
Alsaden looked down at an app on her phone as the pair
approached a tall brick home. A 56-year-old female voter
named Mary lived there, according to the app, Alsaden
reported, and she hadn’t yet voted. “Oh, I like this for
us!” Sandoval said. Mary wasn’t home, and Sandoval
slipped a flyer in support of the amendment on the
doorknob.
Missouri is one of 10 states with abortion rights
initiatives on the ballot this November. And, according
to polls, support for Missouri’s amendment is strong: A
September Emerson College Polling/The Hill survey of
state voters, for example, revealed that 58 percent
planned to vote for the measure.
The Yes on 3 campaign, backed by a coalition of groups
under the banner Missourians for Constitutional Freedom,
has been aggressive. The coalition has raised more than
$30 million — far outpacing groups urging a “no” vote on
the amendment. And while the campaign has received some
large donations and in-kind support from individuals and
organizations across the country, its campaign finance
reports reflect that the effort has been fueled by
thousands of small donations, a seeming testament to a
vigorous text-messaging campaign. Its most recent
quarterly finance report, for example, was nearly 1,700
pages long.
In contrast, groups advocating for keeping the ban in
place — Vote No on 3 and Missouri Stands with Women —
have struggled, despite the efforts of their political
allies to keep the measure off the ballot, including a
failed lawsuit to stop it. As of late October, those
groups had raised about $2 million, which includes a more
than $150,000 infusion of late cash from D. John Sauer, a
former Missouri solicitor general and a member of Donald
Trump’s legal team.
The energy of the campaign was palpable as Alsaden and
Sandoval knocked on doors, even though there weren’t many
voters home along their route. At one stop, Sandoval
asked a man who opened the door whether he’d voted yet.
“Yes,” he replied. “Did you vote ‘yes’ on Amendment 3 to
get rid of the Missouri abortion ban?” she followed up.
“Sure did!” he replied. “Ooh! Love it!” Sandoval said.
“Wooo!” the man replied, taking a few stickers that
signal support for the amendment.
The stakes couldn’t be more clear. If Yes on 3 can get
voters to the polls, the campaign is likely to win — and
Missouri would be the first state in the country to
overturn a total abortion ban in the wake of Dobbs.
The Trigger Ban
The ink had not yet dried on the Supreme Court’s Dobbs
decision on June 24, 2022, when Missouri’s then-attorney
general, Eric Schmitt, hit send on a four-page opinion
addressed to the state’s Revisor of Statutes. Schmitt,
who is now a U.S. senator, confirmed that the court had
shredded the constitutional protection for abortion,
freeing Missouri to end legal abortion in the state.
“This opinion immediately restores Missouri’s deeply
rooted history and proud tradition of respecting,
protecting, and promoting the life of the unborn,”
Schmitt wrote.
In a subsequent press release, Schmitt crowed that the
state would go down as the first to officially, fully
strip millions of residents of their reproductive
autonomy. “My Office has been fighting to uphold the
sanctity of life since I became attorney general,” he
said, “culminating in today’s momentous court ruling.”
Practically speaking, the right to abortion in the state
was already thin. The increasingly conservative
legislature had spent more than a decade stripping away
reproductive rights. By the time lawmakers passed the
trigger bill in 2019 that would allow Schmitt to decree
abortion rights dead, the state had just one clinic, a
Planned Parenthood in St. Louis, left to provide
services. Missouri’s draconian laws had already seen
thousands of residents slip across the state’s borders
for care, including to Illinois — separated from Missouri
by a three-tenths-of-a-mile strip of the Mississippi
River — where lawmakers, providers, and advocates had
been diligently increasing access to reproductive care.
In 2010, for example, Missouri recorded 6,163 abortions
performed in state; by 2021, that number had dwindled to
just 150.
Still, the state’s abortion ban — which contains only a
vague exception for medical emergencies and no exceptions
for rape or incest victims — began wreaking havoc almost
immediately. A hospital system based in Kansas City,
citing ambiguity in the law, stopped providing emergency
contraceptives just days after it took effect, causing
widespread uproar and prompting both Schmitt and Gov.
Mike Parson to claim the hospital system was in the wrong
and that emergency contraceptives were not banned.
Then in August 2022, scary headlines raced across the
state when a woman from Joplin named Mylissa Farmer was
denied an emergency abortion at a Missouri hospital after
her water had broken early. Although doctors determined
that the chance of her fetus surviving was zero, hospital
officials determined she simply wasn’t yet sick enough to
qualify for the exception to the state’s abortion ban.
Farmer finally got the abortion she needed in Illinois.
Across the country since the Dobbs decision, pregnant
people with life-threatening emergencies have hit a
statutory wall, highlighting the cruelty of abortion bans
— and the fundamental nonsense of allowing politicians to
play doctor via state statute. Since 2022, voters in six
states have either fought off efforts to do away with
abortion protections — the first such vote was in Kansas
in August 2022 — or have passed laws to codify
protections for reproductive health care, including in
Ohio. There, nearly 60 percent of voters in 2023 approved
adding a measure to the state’s constitution protecting
the right to abortion.
Not Far Enough
The Missouri amendment is not without controversy — from
inside the reproductive justice movement. Like most
initiatives appearing on ballots this fall, Missouri’s
abortion amendment essentially codifies the protections
outlined in the Supreme Court’s 1973 decision in Roe v.
Wade. The landmark case and its progeny protected
individual freedom only to the point of fetal viability,
at which point it allowed for restrictions on abortion
access.
Fetal viability is typically described at the point at
which a fetus can survive outside the womb, but it is a
tricky thing to pin down, let alone to mandate, given
that every pregnancy is different.
For some advocates, the problem with Roe — and with the
abortion initiatives that mimic its protections — is that
it did not bar the government from intruding on
individual rights, it only set up a scheme for when the
government could stick its head into the examination
room. And that, critics say, gives Missouri lawmakers who
vehemently detest reproductive autonomy too much leeway
to chip away at the amendment’s protections — just as
they’ve done in the past.
Some have argued that Missourians should have held off
collecting signatures to get the citizen-led amendment
onto the ballot this year and instead come up with
expansive language that does away with avenues for
government interference in pregnancy-related decision-
making to put before voters at a later date. By voting
for Amendment 3, “you will actually be embedding a ban
into the state’s constitution because of the viability
language,” Justice Gatson, founder and director of the
Reale Justice Network told Flatland, a nonprofit newsroom
at Kansas City’s PBS station.
The amendment’s authors seemingly attempted to thread
that needle carefully. While the ballot provision says
that the state’s general assembly “may” enact laws that
“regulate the provision of abortion” after viability, it
also says that “under no circumstance” may the government
“deny, interfere with, delay or otherwise restrict” an
abortion deemed necessary by a “treating health care
professional.” It also defines fetal viability as the
point in a pregnancy when a “treating health care
profession and based on the particular facts of the case”
believes that there is a “significant likelihood” of a
fetus’s “sustained survival outside the uterus without
the application of extraordinary medical measures.” While
it does not define what those extraordinary measures are,
it does, at least on its face, define fetal viability on
a case-by-case basis, presumably making it difficult for
the legislature to unilaterally define it.
Should the amendment pass next week, it would take time
to restore rights — and access — within the state, and
advocates would likely have to sue to lift the ban
currently in place. That is the way things have played
out in Ohio; while voters passed the constitutional
amendment in 2023, it wasn’t until October 24 of this
year that a judge there permanently struck down the six-
week ban on abortion that was still on the books.
In Missouri, it seems likely that each of the state’s
myriad abortion restrictions would require separate legal
challenges. “It will be frustrating that every single
day, care is not restored,” Emily Wales, president and
CEO of Planned Parenthood Great Plains, told the Kansas
City Star. “Missourians’ lives are at risk, but we will
be telling that to the courts who have to make these
decisions, and we will do everything we can to restore
access as quickly as possible.”
Meanwhile, anti-abortion lawmakers have signaled that
they’re willing to fight to limit the scope of the
amendment — and the will of voters — perhaps by penning a
repeal measure that would appear on a future election
ballot. “This is not the end all be all,” the rabidly
anti-abortion Republican state Sen. Mary Elizabeth
Coleman told the Missouri Independent. Coleman previously
sought to pass a state law that would bar patients from
traveling out of state for abortion care and fought to
keep Amendment 3 off the ballot. “I think you will see
efforts, win or lose, for Missourians to get another say
in this.”
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