After Missouri banned nearly all abortions in 2022, Dr. Valerie Weaver began noticing a troubling change in some of the pregnant patients she cared for in Kansas City.
They were arriving to her sicker. Some had developed infections, blood clots or other complications while waiting for treatment.
Weaver, a certified registered nurse anesthetist with a doctorate in nursing practice who cares for high-risk obstetric patients, said the problem was particularly acute in situations such as a woman’s water breaking before her fetus could survive outside the womb.
“That law made it so where we couldn’t care for the mother until she had an active threat against her life,” she said.
In 2024, Missouri became the first state to overturn an abortion ban at the ballot box. Weaver said her patients now have a choice they lacked under the ban: End a pregnancy before an emergency develops, even if there is still a fetal heartbeat, or continue the pregnancy.
But Weaver fears those conditions could return after the Nov. 3 election.
Amendment 3 would repeal the reproductive rights amendment Missouri voters approved in 2024 and reinstate an abortion ban with exceptions for medical emergencies, as well as certain fetal anomalies and pregnancies resulting from rape or incest within the first 12 weeks. It would also enact a constitutional ban on gender-affirming care for minors, which is already banned in state statute.
The 2024 amendment, also called Amendment 3, established constitutional protections for reproductive decisions, including abortion, birth control, prenatal care, childbirth and miscarriage care.
Supporters of this year’s measure insist its exceptions would protect women who need abortions.
But some physicians, attorneys and patients who experienced Missouri’s previous ban say the exceptions could prove difficult to implement in practice, leaving doctors uncertain about when they can intervene.
Dr. Sarah Florence, a board-certified family medicine physician from Fenton who spoke in support of the amendment, said the language isn’t written to sacrifice women’s health.
“Sometimes the mother must be separated from the baby in order for her life to be saved, and sometimes for the baby’s life to be saved as well,” she told The Independent. “But that never, ever, in medicine, requires the additional step of intentionally killing the child first.”
Molly Duane, litigation director at Amplify Legal, the litigation arm of Abortion in America, said Amendment 3 defines a fetal anomaly as a “structural or functional abnormality in the unborn child’s gestational development that would make life outside the womb impossible.” The use of the word “impossible,” Duane believes, would exclude many devastating anomalies, because in most cases the infant could be born alive, but die soon after.
Erika found out she was pregnant with her second child in November 2022, months into Missouri’s near-total abortion ban. She agreed to speak to The Independent on the condition that she be identified by her first name, citing concerns for her privacy and the charged political climate around abortion in Missouri.
At Erika’s 20-week anatomy scan, she learned her son, who she named Easton, had a rare fetal anomaly.
But her doctor later determined she could not provide an abortion in Missouri without risking prosecution. Erika and her husband eventually flew to a hospital in Washington, D.C.
There, she had an abortion. After she delivered her son’s body, she held him.
“I didn’t have to watch him suffer and suffocate to death,” Erika said. “He was able to be given the compassion and the dignity that I believe he deserved.”
After Missouri passed the reproductive rights amendment, Erika and her husband decided to try again. Her doctor reassured her that if anything went wrong this time, she could get care without leaving the state.
“Amendment 3 is incredibly personal to me,” she said from her Kansas City home, where she recently brought home her infant daughter.
Rape and incest exceptions
Lawmakers removed a proposed police-reporting requirement before placing the measure on the ballot.
Julie Donelon, president and CEO of the Metropolitan Organization to Counter Sexual Assault, has concerns with the 12-week deadline. It often isn’t long enough for survivors to discover they’re pregnant, process the trauma of the assault and then seek out care, she said.
“We know that providers won’t be readily available,” Donelon said. “That could really push that deadline of the 12 weeks exception for rape and incest survivors.”
Would abortion clinics remain open?
Michael Wolff, a former chief justice of the Missouri Supreme Court, expects the court orders blocking the old abortion restrictions to fall away. That could leave Planned Parenthood providers unable to offer even abortions allowed under the exceptions.
Dr. Jennifer Smith, a St. Louis OB-GYN who is campaigning with Stop the Ban, said patients who qualify for an exception could still struggle to get care at hospitals, especially if the procedure isn’t covered by insurance.
If Amendment 3 passes, it would take effect 30 days after the election.