Missouri's Planned Parenthood affiliates will offer medication abortions next week for the first time since 2018 after a Jackson County judge struck down a slew of restrictions on Thursday.
While the ruling will be appealed, Jackson County Judge Jerri Zhang's decision marks arguably the most legally significant move since Missourians approved an amendment protecting abortion rights in 2024.
"This monumental win for reproductive freedom and abortion access is possible only because of the Right to Reproductive Freedom Amendment that Missouri voters passed in 2024," Gillian Wilcox, director of litigation at the ACLU of Missouri, said in a statement.
State voters backed a constitutional amendment, known as Amendment 3, that legalized abortion up to fetal viability, which is usually around 24 weeks of pregnancy. Hours after the vote, Missouri's Planned Parenthood affiliates sued to strike down numerous abortion restrictions – including the state's near-total ban on the procedure and licensing requirements for clinics, which they said violated the new amendment.
Missouri Attorney General Catherine Hanaway condemned Thursday's ruling in a statement, saying it was "exactly the Pandora's box we warned of, and the women of Missouri will pay the price."
State officials said in the 10-day bench trial earlier this year that the statutes were necessary to keep patients safe.
On Thursday, Zhang ruled in favor of Planned Parenthood on most of its lawsuit counts – including its effort to strike down what's known as a complication plan for medication abortions. That spells out what clinics would do if there's a medical emergency after someone has a medication abortion.
Zhang upheld the statute for the complication plan in earlier rulings but wrote on Thursday the law "conflicts with the language of Amendment 3."
She struck down most of the 40 regulations Planned Parenthood had argued violated the new amendment, including requirements that patients wait 72 hours before an abortion, that providers have admitting privileges at a nearby hospital and rules governing the staffing and construction of facilities.
Zhang also ruled against what Planned Parenthood called a "telemedicine ban," which requires patients to take abortion pills in the presence of a physician.
In a statement, the leaders of Kansas City and St. Louis' Planned Parenthood affiliates announced that Missourians could immediately schedule medication abortions online and that clinics will offer medication abortions beginning next week. Planned Parenthood started offering procedural abortions in 2025.
"Once again, the courts have affirmed Missourians' constitutional right to access abortion without interference or delays from their government," Margot Riphagen-Dunn, president and CEO of Planned Parenthood Great Rivers, said in a statement. "The truth is, medication abortion is the most common form of abortion care, and has been proven to be safe and effective for the past 25 years. Yet, since Missourians voted for abortion access in 2024, it has been impossible to access the full spectrum of abortion care in our own state. That ends today."
According to the Guttmacher Institute, medication abortion comprises nearly two-thirds of all abortions in the country.
Not the last word
Hanaway decried the demise of laws restricting abortion providers, adding, "the state cannot even conduct basic health and safety inspections to ensure patient safety."
She said her office would appeal the ruling.
"None of this is what Missourians voted for," Hanaway, a Republican, said. "My office will expeditiously appeal this dangerous decision to the Missouri Supreme Court, and I will never stop fighting for the safety of women and children."
Zhang had predicted that her ruling would not be the last word.
"The court has given this matter much thought and has tried to decide this matter as expeditiously as possible so the parties may continue their litigation journey to the Missouri Supreme Court," she wrote.
Missourians are slated to vote in November on a proposal, which is also known as Amendment 3, that would repeal the 2024 amendment and replace it with a near-total ban on abortion. The amendment would allow for abortions for up to 12 weeks in the case of rape and incest and contains exceptions for life and health of the mother.
Backers of the new Amendment 3 have focused much of their campaign messaging on a separate provision in the proposal banning gender-affirming care for minors. Lawmakers already prohibited puberty blockers, hormone therapy and gender-affirming surgery for minors through statute but did not eliminate a 2027 expiration date this past session.
Abortion rights supporters have pledged to defeat Amendment 3 in November, arguing that voters already spoke on the issue.
"Abortion is a basic and essential part of health care, and today that was recognized by a Missouri Court," Maggie Olivia of Abortion Action Missouri said in a statement. "Thanks to November 2024 voters, Missourians have a constitutional right to abortion. This November we will vote to keep it when we vote no on 3 and stop another abortion ban."
Even before the 2022 U.S. Supreme Court ruling that paved the way for Missouri's near-total ban, abortion providers rarely performed the procedure in the state. Neighboring Illinois had far fewer restrictions than Missouri, and the St. Louis affiliate would send many of its patients seeking the procedure to the clinic in the Metro East.
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