Voters passed Amendment 3 in November to guarantee abortion rights in the Missouri Constitution. That kicked in Dec. 5.
But that voter action followed decades of work by the General Assembly to regulate abortion into oblivion.
So now state courts must reconcile those myriad regulations attacking abortion with the fresh constitutional amendment that promises access to abortion.
A judge tossed out several laws on Dec. 20 that clinic operators argued had made abortion access impractical in Missouri.
Jackson County Circuit Judge Jerri Zhang blocked a 72-hour waiting period for an abortion and requirements that physicians performing abortions must first have admitting privileges at nearby hospitals.
But Planned Parenthood Great Plains, Planned Parenthood Great Rivers and the ACLU of Missouri issued a joint statement after the ruling noting that clinics still needed to overcome license requirements.
“As a result of today’s mixed decision,” they wrote, “Missourians continue to be deprived of time-sensitive, essential, and constitutionally protected health care, despite voting in favor of a constitutional right to abortion.”
Still, a range of heavy regulations called targeted regulation of abortion providers, or TRAP, laws are technically part of Missouri law — leaving murky legal territory on what reproductive services clinicians can provide, and with what restrictions.
The laws don’t expressly ban abortion — after all, most were passed when the U.S. Supreme Court’s now-moot Roe v. Wade decision offered federal protection for abortion rights. Rather, they were designed to overwhelm abortion with restrictions to make it nearly impossible to comply with the state rules.
Abortion-rights supporters now hope to nullify those laws. But even with potential courtroom wins, women living in rural Missouri will likely face more barriers to getting an abortion than their counterparts in urban and suburban parts of the state.
“For abortion access, the rural parts of the state have been decimated for a long time,” said Emily Wales, the CEO of Planned Parenthood Great Plains. “There’s not been truly accessible abortion care for many, many years in rural parts of Missouri.”
How TRAP laws left rural abortion access obsolete in Missouri
After abortion was codified under Roe v. Wade in 1973, states with lawmakers who opposed abortion access began passing laws aimed at limiting it. They included laws that made clinic licensing, accreditation and other operations increasingly difficult.
Missouri lawmakers began layering restrictions on abortion providers by the late 1980s. That slowly chipped away at access to abortion.
Rural Missourians were the first to feel the lack of access from a law that required abortion clinics to meet the same requirements as ambulatory surgical centers. Rules such as specific hallway widths and other operational requirements made it difficult for rural clinics to continue providing abortions.
Other Missouri laws required doctors who performed abortions to have admitting privileges to a hospital, which can be difficult for physicians to receive if they aren’t performing a certain number of procedures or don’t admit many patients to a hospital on a regular basis.
Proponents of the measures say they protect the health of patients. Abortion providers argue they place undue burden on their operations.
“TRAP laws just absolutely make it harder for providers to keep their compliance,” said Candace Gibson, the director of state policy at the Guttmacher Institute, which supports abortion rights. “They sometimes force providers to stop providing care.”
From 1982 to 1992, 17 abortion providers closed in Missouri, leaving the state with 12 abortion providers.
Later, the various laws eventually left St. Louis as the only place in the state where women could get an abortion.
But out-of-state travel has become the norm for Missourians seeking abortions. Data from the Guttmacher Institute show that from January 2023 to August 2024, 2,850 Missourians traveled to Kansas for an abortion and 8,750 went to Illinois.
An August survey from the Kaiser Family Foundation found that 35% of women living in rural areas nationwide reported they wouldn’t know where to find information about receiving an abortion, compared to 25% of women living in urban or suburban areas.
Planned Parenthood and other abortion-rights supporters know how much has changed in Missouri since the majority of providers left the state.
“We know … that there are patients who book appointments from rural parts of the state who maybe could have gotten 45 minutes from home or an hour from home, but traveling two-and-a-half or three hours just isn’t doable,” Wales said. “Patients tell us, ‘If I can figure it out, I will show up. If I can’t, it’s because I can’t get there.’”
The path forward for restoring rural access
Even before Amendment 3’s passage last month, Missouri lawmakers vowed that they would work to overturn the constitutional amendment if voters approved it.
Abortion-rights supporters are keeping Missouri’s historical opposition to abortion in mind as they work to restore access to the procedure.
“We’ve already heard a lot from legislators that they are going to do everything within their power to overturn this,” said Michelle Trupiano, the executive director at the Missouri Family Health Council, the state’s provider for Title X, a federal program that supports reproductive health care. “I don’t think the culture and climate of reproductive health access in Missouri has changed overnight. It’s still going to be a very hostile climate.”
Alongside dwindling abortion access, health care access has declined over time in Missouri.
“Family planning care and access to contraception face the same barriers and challenges due to health care shortages in general, specifically in rural areas,” Trupiano said.
From 2014 to 2023, 12 rural hospitals closed, leaving 50 rural counties without hospitals. All of those hospitals were located in areas that have a shortage of health care providers. Over 32% of Missouri’s population lives in rural areas, but only 23% of the state’s available health care providers practice in rural counties.
A study found that after Missouri’s near-total abortion ban went into place, applications for OB/GYN residencies dropped over 25%.
Those are larger challenges that point to a long path ahead.
“We want care to be restored,” Wales said. “But to make it really accessible, we have to have it available in local communities, and that’s going to be a longer process.”
This story was originally published by The Beacon, a fellow member of the KC Media Collective.
