On Election Day last November, supporters of reproductive rights in Missouri were quietly hopeful. For more than two years, abortion had been all but illegal in the state, owing to a trigger law that went into effect minutes after the Supreme Court issued its Dobbs v. Jackson decision, overturning Roe v. Wade. Only in the case of a medical emergency could a woman get an abortion of a viable fetus, and anyone who provided an abortion under other circumstances would be guilty of a felony. But for months opponents of the law had been campaigning to pass Amendment 3, which would enshrine in the state constitution one’s right “to make decisions about reproductive health care” without government interference. They drew inspiration from neighboring Kansas, which, despite its G.O.P. leanings, had voted by eighteen points to preserve abortion rights, and from a half-dozen other states, including Kentucky and Ohio, which had followed suit.
Then again, Missouri was one of the most conservative states to put abortion rights to an electoral test since Dobbs. The last time a Democratic Presidential candidate had won Missouri was in 1996, and, this time, Donald Trump was certain to defeat Kamala Harris and lead a Republican sweep of statewide offices. Josh Hawley, the state’s senior U.S. senator, was insisting, against all evidence, that Amendment 3 wasn’t about abortion but, rather, about providing gender-affirming care to minors. He falsely called it “an effort to come into our schools, behind your backs, without your knowledge, to tell our kids that there’s something wrong with them and to give them drugs that will sterilize them for life.”
Deborah Haller, a retired nurse, who spent nine years running the public-health department in rural Johnson County, about an hour east of Kansas City, knew that thousands of women were crossing the border into Illinois and Kansas to end their pregnancies, and that many others were securing abortion pills through telemedicine. Missouri’s restrictions were “unconscionable,” Haller told me. On Election Night, she was thrilled when 51.6 per cent of the state’s voters said yes to Amendment 3, but she soon said to her husband, “I wonder how long it’ll be before they knock it down.” Relating their conversation to me, she said, “It didn’t take long.”
Less than twenty-four hours after the polls closed, Missouri’s two Planned Parenthood clinics filed suit, asking a court to honor the result and lift medically unnecessary abortion regulations that were on the books in the state, including a seventy-two-hour waiting period, a ban on providing abortion medication through telemedicine appointments, mandatory pelvic exams, and a requirement that clinics be licensed as ambulatory surgical centers. The limitations, in effect since 2018, had left Missouri with just one abortion clinic in the years before Dobbs. Sure enough, attorneys for the Republican-led state government objected, saying that the regulations must be enforced to protect patients.
It was not until February that a Kansas City judge temporarily struck most state regulations targeted at abortion providers, even as she allowed several others to remain, such as the condition that clinics fulfill the standards for ambulatory surgical centers. Three Planned Parenthood clinics began administering abortion care, but the government appealed, and the state Supreme Court halted abortions in May. The case has gone back and forth, with the judge ruling anew in July that surgical abortions can take place, for now at least, and the state, again, filing an appeal. The office of Missouri’s secretary of state has issued a rule that effectively blocks clinics from providing medication abortions, which account for nearly two-thirds of abortions nationwide. Upping the pressure, the state’s attorney general, Andrew Bailey, sued Planned Parenthood on July 23rd, calling the organization a “death factory.” (He has since been named the co-deputy director of the F.B.I.) Most troubling to abortion-rights proponents: Republicans in the Missouri legislature decided to place a new constitutional amendment on next year’s ballot which would severely restrict abortion all over again. In passing the measure, Republican legislators said that voters must not have understood what was in Amendment 3, or it surely would have been defeated.
Missouri is not the only state where anti-abortion activists have countered post-Dobbs gains on abortion rights. In Ohio, despite a 2023 referendum that prohibits the state from “burdening, prohibiting, penalizing, and interfering with access to abortion” before viability, challenges to abortion rights are working their way through the courts. Even states with significant abortion bans are witnessing intensifying attempts to make reproductive care more challenging to obtain. Texas and Louisiana, for example, are targeting a New York doctor for allegedly violating state laws when she prescribed abortion pills to patients in their states. Louisiana passed a law last year that classifies mifepristone and misoprostol as controlled substances, potentially delaying lifesaving treatment for pregnant women and making it more difficult for them to manage miscarriages. (The law is being challenged in court; legislators in states such as Missouri have introduced similar legislation.) Candace Gibson, the director of state policy at the pro-choice Guttmacher Institute, called the prospect of such legislation “Terrifying.” She added, “Unfortunately, what type of care you can access really depends on where you live.”
When I went to see Selina Sandoval, an ob-gyn at the Kansas City Planned Parenthood, the clinic was offering abortions for just the second time since the July ruling. Sandoval explained that, amid the shifting landscape, she is updated promptly by the organization’s attorney when new information comes in. “Even as someone who’s doing this care every day, it is so hard to follow what’s going on,” she told me between appointments. (She also sees patients across the state line in Kansas.)
The on-again, off-again access to abortions in Missouri has made it difficult for Planned Parenthood clinics to prepare for the periods when abortion has been allowed. They can’t always train and assign staff in an instant, or easily schedule doctors or spread the word that they’re open for business. The uncertainty is “really disruptive to care, which obviously is the goal,” Sandoval said. Emily Wales, the president and C.E.O. of Planned Parenthood Great Plains, which includes central and western Missouri, noted that, for years, clinics have told patients that their care may be interrupted. “We had appointments available,” she said, “but we would tell people as they booked them, ‘We have a license renewal coming up,’ or ‘We have an injunction in place that has a hearing, so let’s go ahead and create a backup plan.’ ”
Of ten available appointments on the day I visited, only seven were filled in advance. I spoke with one patient, a twenty-eight-year-old medical assistant and mother of four young children. She had assumed that she would have to travel for treatment, as a friend had, and had been startled to discover that she could get an appointment in Kansas City. If she’d had to travel for an abortion, “it would have caused chaos in my life,” she told me. “It would have been a struggle to have to take off work, and then, on top, it’s just already overwhelming.”
Angela Huntington spends her workdays, and many of her off-hours, creating what she calls a “soft landing” for abortion patients from Missouri and beyond. Based in Columbia, two hours east of Kansas City, Huntington is part of a network of patient “navigators” who buy plane tickets, send rideshare gift cards, reimburse hotel and child-care costs, and arrange payments for abortions that patients otherwise could not afford. In 2024, a hundred and fifty-five thousand people crossed state lines for abortions. “There’s so much meaning to what I do.” Huntington told me. “I don’t know if I could do anything else.” On the day we met, she was working with an unhoused woman who lived thirty-five miles from the nearest airport. The woman had never flown, and she was stopped by airport security because she did not have a Real I.D. or a home address that matched her proof of identification. “It’s a mess,” Huntington said.
One woman’s effort to get an abortion spanned five states. A nurse and mother of five girls in a small town in southern Missouri, she was delighted when she found out, earlier this year, that she was pregnant with a boy. Testing, however, soon revealed trisomy 18, a genetic abnormality that is usually fatal, often before birth. Few infants born with the condition live more than a year, and their short lives are marred by feeding and breathing difficulties and other forms of distress. The woman learned that her unborn son—whom she and her husband had named Mychael—had a particularly severe case. “We went to all the appointments. We did all the ultrasounds,” she told me. “Beyond a miracle happening, there was no way we were delivering a healthy child free of pain.”
