Abortion is on the ballot in Missouri – two years after voters chose to protect it
GLADSTONE, Mo. — Missouri’s constitutional right to abortion is on the verge of disappearing again.
It was a threat that loomed over Tiffany early one recent September morning, as she drove to Gladstone, just north of Kansas City, for her abortion.
The 26-year-old mother of three made the two-day trip to the clinic just weeks after discovering she was pregnant. Although she lives in Springfield, a city of about 170,000 near the Arkansas border, she wasn’t able to find an abortion appointment at her local clinic until late October, near the end of her first trimester.
Instead of waiting, she decided to spend the night at a friend’s house, halfway between her home and Planned Parenthood of Gladstone — the first clinic that could take her — a few hours away. After her appointment, she planned to return home in time to meet her children when the bus dropped them off.
“I love children so much,” she says, sitting on an examining table, waiting to see the doctor. This abortion, she explained, “has everything to do with loving my own children, who I have already chosen to have.”
But come November, the rights of Missourians, including Tiffany, to receive such care — which gradually became more available after the 2024 vote to enshrine the right to abortion in the state constitution — could come to a screeching halt.
A proposal known as Amendment 3 would overturn that vote and ban abortion in the state constitution, allowing the procedure only in rare cases: when pregnancy constitutes a medical emergency, upon discovery of a fetal abnormality or before 12 weeks in cases of rape or incest. It would also ban gender-affirming care for transgender minors, even though such care is already illegal in Missouri.
The measure, introduced by the state Legislature months after the 2024 vote that dismayed conservative lawmakers, would make Missouri the only state in the country whose constitution explicitly bans abortion. If successful, it could inspire similar efforts in other states whose governments are largely made up of lawmakers opposed to abortion but whose residents voted to protect reproductive rights, like Ohio, Montana or even neighboring Kansas.
“I look at the Constitution as something that’s supposed to protect us, and that doesn’t seem very protective,” Tiffany said.
Tiffany, who asked that her last name be withheld because she told few people about her abortion, knew terminating her pregnancy was the right choice. A fourth grade teacher, she also has a part-time job on the weekends and drives for Lyft and Doordash in her free time. Still, she struggled to pay her bills. Now, a new source of tension: she and her husband, with whom she had lived since the age of 17, separated in July. Divorce would be yet another thing to pay, one more burden for her children.
She had not wanted to keep her first pregnancy 10 years ago. But she was 16 and had no choice; she couldn’t find anyone in Missouri who would give her an abortion. From now on, she said, she would travel wherever she had to, even out of state. Credit card debt was nothing compared to what having another child would do to her family.
“I would have continued to exhaust every option to find a way out that wasn’t having a baby,” she said.
Her last pregnancy, three years ago, had also been difficult. At 30 weeks, she was diagnosed with preeclampsia, a dangerous high blood pressure condition that left her with residual kidney damage. When she had her son less than a month later, he stayed in the hospital for weeks.
At the Gladstone Clinic, she was given two medications: mifepristone, to stop her pregnancy from growing, and misoprostol, which she took at home to expel the embryo inside her.
It was the fourth clinic she contacted and the first that could see her, reflecting the difficulty of having an abortion even in a state where this right remains, for the moment, enshrined in the constitution.
The 2024 vote that established the right to abortion in Missouri overturned a ban that had taken effect the day Roe v. Wade fell in 2022. But translating that into actual clinics offering appointments and allowing patients to have abortions has been a slow, painstaking process in a state that, for years before Roe ended, had made the procedure nearly impossible to implement because of a litany of restrictions. By the time Roe came down, providers had already stopped performing abortions except at one clinic in the state.
Reproductive health clinics across the state have had to build their abortion offerings almost from scratch since 2024, recruiting doctors and training staff, many of whom had never worked at clinics offering the service.
Even today, two years after the vote, it is not easy to find appointments for abortions in Missouri. Planned Parenthood Great Plains, which operates most of the six clinics available statewide, provides abortions eight or 10 days a month. Planned Parenthood in Gladstone, where Tiffany was finally able to have an abortion, only began offering the service in July.
Missouri’s General Assembly, controlled entirely by Republicans, has pushed to weaken or even roll back abortion protections — leading to the state’s vote last year to place Amendment 3 on the 2026 ballot.
The campaign is fierce, with ads supporting Amendment 3 even airing during a prime-time Kansas City Chiefs game. The Amendment 3 campaign, treasured by state First Lady Claudia Kehoe, has raised more than $1 million. The abortion rights camp has nearly $5 million on hand, including massive donations from progressive heavyweights like the American Civil Liberties Union and political advocacy arm Planned Parenthood.
An August poll by St. Louis University pollsters found a nearly even split among voters, with 43 percent saying they support Amendment 3 and 44 percent expressing opposition. Thirteen percent were undecided.
Supporters of Amendment 3 are particularly leaning on the ban on gender-affirming care — which the August poll found is far more popular than the abortion ban — in hopes of avoiding the same defeat they experienced two years ago.
“We’re trying to do everything. We’ve had canvassers knocking on thousands of doors,” said Tom Estes, a Republican Senate staffer working on the campaign for Amendment 3. “There are several elements that resonate very well, that maybe we didn’t understand last time. The number one element is the trans issue.”
The anti-Amendment 3 campaign declined to make anyone available for an interview.
Some health care providers say remaining state restrictions on abortion — including limitations on insurance coverage — combined with looming uncertainty over whether abortion will still be legal after the election have undermined their efforts to expand their offerings.
“I would love to provide abortion services four to six days a week in Springfield,” said Dr. Margaret Baum, chief medical officer of Planned Parenthood Great Rivers, which began offering abortions at its Springfield clinic in July. “I think the demand is there.”
But achieving that, she said, would require hiring new staff and possibly physically expanding the clinic. These are “costly decisions” that are difficult to commit to without knowing how the election will play out, she said. Currently, abortions are only possible when a doctor can travel to town to perform them. It’s often Baum, who lives across the state in St. Louis.
In addition to opposing Amendment 3, providers are currently challenging a state law requiring that abortion — usually a simple procedure that can be performed by a nurse practitioner — be performed only by doctors. Such a law treats abortion differently from other forms of health care, they say.
“We’re getting questions from patients saying, ‘I see this is on the ballot again, should I think now about whether I can get care in Missouri?’ ” said Emily Wales, director of Planned Parenthood Great Plains. “We’re trying to tell people, ‘You can still come and get treatment, health care continues.’ »
By the time Tiffany had the abortion, she had spent about $120 on gas, a few hundred dollars at a Wichita hotel where she had stayed the previous weekend in the vain hope that a clinic might get her an appointment, and hundreds of dollars more on the medication that ended her pregnancy.
When she got home, she said, she didn’t think she would have much time to recover. She was already thinking about how many hours she would have to work to recoup what her abortion had cost her. She had work. She had the children.
Maybe in a few days she would have a chance to sit down and think about everything that had happened.
“I just have to keep being a mom,” she said.
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