One year ago, abortion became legal in Missouri. But since then, only 80 elective abortions have been performed in the state. Thousands of Missourians had to seek care out of state.
This is the reality until a trial plays out next year to determine which of Missouri’s anti-abortion laws violate a voter-approved reproductive health care constitutional amendment passed last year — and which can remain in place.
“It’s hard to hear after we’ve had the vote,” Emily Wales, president and CEO of Planned Parenthood Great Plains said. “Even knowing that the case really is moving at a wild speed and that we are pushing for trial as quickly as possible.”
Looming on the horizon is another statewide vote on abortion. Republican lawmakers placed a new constitutional amendment on the 2026 ballot that would ban nearly all abortions in the state, with limited exceptions for survivors and for medical emergencies.
Abortion may be legal again in Missouri, but for most patients, it’s not yet within reach.
Decades of restrictions have gutted the state’s provider network. Now, Planned Parenthood is the only option. And medication abortion — the method most people previously relied on — is still unavailable as the courts sort through which old laws conflict with the new constitutional amendment.
Some abortion-right advocates say this was all inevitable, arguing the amendment approved by voters last year didn’t go far enough. Others push back, saying access can’t be restored overnight even under the best circumstances.
“It takes time to rebuild infrastructure that was decimated over decades,” said Mallory Schwarz, executive director of Abortion Action Missouri.
It leaves activists on both sides of the abortion debate asking how best to move forward when so much is in flux.
“If you want an abortion, you want to make that call now. You don’t want to have to wait and see what the state might do to interrupt your care,” Wales said. “And Missourians are thinking about that. When they call us, they are asking, ‘Is care really going to be available and what might happen,’ which is almost impossible for us to say.”
Between January and October, there were 80 in-clinic abortion procedures 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.
An additional 79 abortions were performed in Missouri hospitals. All were marked as being medical emergencies when reported to the health department.
State Sen. Mary Elizabeth Coleman, who helped pass Missouri’s trigger law that banned abortion in 2022, questioned whether the national donors who bankrolled the passage of the abortion-rights amendment last year will open up their checkbooks again to fight the proposed ban next year.
In 2024, anti-abortion groups were outspent six to one.
“They spent $30 million for 80 abortions. Are they going to do that again? I don’t know,” said Coleman, an Arnold Republican. “We’re a bad place to invest if you are part of the national pro-abortion movement because we’re not going to stop and we’re going to continue and we’re more unified than we used to be.”
Rebuilding infrastructure
To say Julie Burkhart knows something about running an abortion clinic in a hostile environment is an understatement.
Burkhart worked for Dr. George Tiller’s abortion clinic in Wichita, Kansas, when an anti-abortion activist fatally shot Tiller in 2009. More than a decade later, Burkhardt opened an abortion clinic in Wyoming in spite of the state’s abortion ban.
She is also co-owner of Hope Clinic, a private abortion provider in Granite City, Illinois, located a 15 minute drive northeast of downtown St. Louis. Between 2019 and 2022, the numbers of Missourians making the short trek to her clinic more than tripled.
The year Tiller was murdered, 6,881 abortions were performed in Missouri, according to state health department data. By 2021, there were only 151.
In 2024, it’s estimated 7,780 Missourians traveled to Illinois and 3,960 traveled to Kansas to access abortion, according to the Guttmacher Institute, a reproductive rights research group.
In Missouri, in what used to be a network of private and non-profit abortion clinics, Planned Parenthood now stands alone.
“ When we have clinics closing because of government hostility, it’s not an abstract function. It’s not theoretical,” Burkhart said. “What that does is that puts more pressure on real people who are just trying to live their lives, make the best decisions about their lives, the lives of children that they might already have.”
Last year, Planned Parenthood Great Rivers, which is based in St. Louis and operates clinics in the metro area and in the Ozarks, announced the closure of three locations in North St. Louis County, south St. Louis city and Joplin in order to expand telehealth services.
This year, at least 45 Planned Parenthood clinics around the country have shuttered, many due to the ban on abortion providers receiving Medicaid reimbursements.
“If you don’t have that infrastructure, then it’s just chaotic,” Burkhart said. “People are left not knowing if something’s available or not, or to what limit or not, and it’s just incredibly stressful and chaotic for patients.”
Burkhart has no plans to open an abortion clinic in Missouri, though she sees a “desperate need” for more providers.
But if a private provider were interested in moving into Missouri, she said they would likely face challenges like finding a financial institution willing to finance them. And she’d advise waiting until after the parameters of the abortion rights amendment are fully litigated and the November vote on the abortion ban.
“I feel like I’m painting a very grim picture,” she said. “Start-ups can be done, but I think it’s just a matter of good strategy, time and patience to navigate all those hurdles.”
Margot Riphagen, CEO and president of Planned Parenthood Great Rivers, said there is early talk of restarting abortion procedures at the other clinics she oversees (including in Rolla, Springfield, St. Peters and western St. Louis County) after the January trial offers some legal clarity.
At the Planned Parenthood clinic in St. Louis’ Central West End, abortions accounted for less than 1% of all services provided in the 2025 fiscal year ending in June. The majority of appointments were for STI screenings.
The clinic did not provide the total number of abortions it performed in the past year, but said 20% of the abortion patients came from out of state. The clinic is currently offering abortion appointments once a week for patients up to 18 weeks gestation, said spokesperson Krissy Durant.
Wales, with Planned Parenthood Great Plains, hopes for a day when abortion doesn’t rest solely on Planned Parenthood’s shoulders.
“What I want as a Missourian and as someone who wants people to have access to their own fundamental rights is for there to be providers in every single community who have patients in the waiting room who are there to get obstetrical care or regular checkups or wellness visits or abortion care,” she said, “ … That is what real access to abortion looks like. The challenge we have, though, is getting to that point of normalizing care and having providers feel safe enough to do it.”
Robin Frisella, community engagement director for Missouri Abortion Fund, said conversations about rebuilding access often neglect strategies to fund abortion.
“When you fund abortion, you are funding the immediate needs of abortion seekers right now,” she said. “You don’t have to wait for elections. You don’t have to wait for amendments to pass to make a real difference in abortion access.”
Missouri law prevents private insurance companies from covering any abortion costs. Federal law bans the use of federal funds, such as Medicaid.
The average cost of an abortion in the first trimester is about $600, Frisella said. Abortions later in pregnancy can cost upwards of $10,000.
So far in 2025, the fund has paid for out-of-state abortions for more than 1,570 Missourians. But the past few years have seen a steady decline in donations, Frisella said.
Missouri Abortion Fund is also part of What’s Next, a group made up of reproductive justice activists and organizers who previously called for a constitutional amendment to appear on the Missouri ballot with no restrictions on abortion.
“When amendment three is considered a win, it gives the false impression that this issue has been solved in the state,” Frisella said. “What a win looks like for abortion access is not limited appointment availability.”
Republican response
In October, former Missouri Republican Gov. Mike Parson stood before a room of Missouri Baptists and warned they may be facing their “last chance” to remove abortion rights from the Missouri constitution.
“If we don’t get it done this time,” Parson cautioned, “you’ll be fighting this issue for a long, long time.”
State Rep. Brian Seitz was in the crowd.
“Society in general is changing,” Seitz said. “I don’t know that the ideas that some of us have, as conservatives and/or Christians, are really holding sway as much as they did 10, 20, 30 years ago.”
“If the Missouri voter says no to this one, can we run the same thing again?” Seitz said. “ I don’t think so.”
While nothing is stopping the legislature from trying again to ban abortion if next year’s vote fails, Seitz said he thinks a repeat attempt is unlikely. Instead, he said, the fight would take a different form.
He thinks the best path forward is legislation that would establish fetal personhood. This means that from the moment of conception, an embryo, and then fetus, would have full rights as an individual. This could “negate” the abortion rights amendment, he said, because abortion could then legally become classified as murder.
Coleman, the Arnold Republican senator, said if the abortion ban fails at the ballot next year, she will immediately go back to the drawing board to find a new path to restrict the procedure.
“ This fight isn’t going to go away. I will never stop working on this, and I am one of hundreds of thousands of Missourians who will never stop fighting to protect the unborn,” Coleman said. “The idea that there is one end all be all, it’s not true.”
Legislation pre-filed by state Sen. Mike Moon, a Republican from Ash Grove, and state Rep. Burt Whaley, a Republican from Clever, seeks to charge anyone who has or performs an abortion with murder.
“Instead of protecting a culture that allows the shedding of innocent blood, we must protect preborn babies from abortion and the souls of the mothers who commit them by deterring abortions in the first place,” Whaley said in a statement. “This legislation will help us accomplish this simple directive from God.”
‘Changing culture’
Sam Lee, an anti-abortion lobbyist who has spent decades roaming the Missouri Capitol, has been collecting books by progressive activists on topics like environmentalism and violence.
“They’re really instructive to me in terms of what could be done,” he said. “If we’re going to have a pro-life culture or a culture that respects life, then maybe we need to teach kids that, as opposed to just dealing with guns on one side or the other. What about just relationships? It’s an idea; we’ll see.”
Lee hopes these texts may give him some insight into how to motivate a younger population to his movement.
“I’m talking about changing culture. Gosh, we lost by just 1.6%; such a close vote,” Lee said. “What could we have done 10 or 15 or 20 years ago, where we could have won that? It’s a legitimate question, and it’s a legitimate criticism of the pro life movement if we could have dealt with it, and we didn’t, when we were focused almost exclusively on trying to overturn Roe versus Wade.”
The question of messaging is top of mind for those on both sides of the abortion movement.
This fall, volunteers with Abortion Action Missouri started hosting house parties to invite their friends and neighbors to talk about and learn about abortion.
Schwarz, with Abortion Action Missouri, said her organization made a conscious effort to shift toward normalizing the phrase “pro abortion” a few years ago, noting that anti-abortion groups were far more likely at the time to say the word “abortion” out loud.
“How silly that we have ceded that ground to them in favor of something like choice, or women’s healthcare or reproductive healthcare,” she said.
Schwarz said she sees the destigmatization — something crucial to winning over more support as she knocks on more doors in parts of the state that are historically more conservative and Christian.
“It is freeing. People are itching to talk about this experience, and stigma has kept them silent,” Schwarz said. “Being approached at their door or invited to a meeting, it helps people heal from the shame that they experienced themselves, and they see that they didn’t need to.
Schwarz said putting abortion on the ballot and winning is not the end all be all.
“The only path towards a Missouri where we’re not fighting the same attack year after year after year is one where we change the composition of the legislature,” she said. “ … “It was never sufficient for us to look at a 10 plus year plan to flip the state legislature and think we could just live under a ban during that time.”
Jamie Morris, executive director of the Missouri Catholic Conference, said the slim margins of the November 2024 vote re-energized the anti-abortion voters.
This time around, he’s hopeful the campaign in favor of the abortion ban will be better-funded.
“ It’s easy to go back and sort of Monday morning quarterback, but we lost by 1.6%,” he said. “You don’t even need another $30 million. You just need to raise a little bit more and target in certain areas a little bit sooner than I think our side did last time.”
He also hopes part of the messaging, including what’s preached to those in pews, focuses on laws that help women choose to continue a pregnancy.
“Is it a financial issue? Is it the social safety net that we need to bolster? Is it childcare issues?” he said. “Pick that public policy topic, but it’s all of these things that help women decide to have the child. How can we impact that and really focus on the women who feel like they have no other choice?”
For now, Missourians sit in the uneasy space between a constitutional right and the reality on the ground — a state where voters restored abortion access, but where it remains largely out of reach.
“(Lawmakers) can sow chaos on their end,” Wales said. “We’re just going to keep organizing and coordinating and moving with one vision for Missourians to be healthier and safer and free.”
This story was originally published by the Missouri Independent.
