Missouri voters restored abortion rights in 2024, but a new court fight will decide whether those rights can actually be exercised inside the state.
Last month, attorneys for the Missouri Attorney General’s Office and Planned Parenthood faced off in a Jackson County courtroom over whether Missouri can continue enforcing abortion regulations that providers say still block access, even after voters approved a constitutional amendment protecting abortion rights.
At issue is a set of long-standing restrictions known as Targeted Regulation of Abortion Providers, or TRAP, laws. While the amendment legalized abortion, it did not automatically repeal those rules. Planned Parenthood and the American Civil Liberties Union of Missouri argue that some of the remaining requirements conflict with the amendment and make it impossible to provide care. The state says the rules are needed to protect patient safety.
Planned Parenthood told the court that Missouri’s abortion regulations have piled up over time, especially as anti-abortion lawmakers gained power, creating barriers that clinics cannot realistically overcome.
The state countered that abortion carries risks that justify continued oversight.
“The risks associated with abortion don’t just exist in the abstract,” Assistant Solicitor General Alexandria Overcash said. “Real women, Missouri women have suffered.”
Doctors and medical experts called by Planned Parenthood disputed that claim, testifying that abortion is safer than many common medical procedures, including childbirth.
“There’s nothing like sitting in your patient’s pool of blood as she’s bleeding out four liters of blood to realize that a healthy term pregnancy has a whole hell of a lot of risk,” testified Dr. Jennifer Smith, a St. Louis OB-GYN.
Most of Missouri’s abortion restrictions, including the state’s near-total ban, were temporarily blocked by Jackson County Circuit Judge Jerri Zhang before the trial. But several requirements remain in force, including a mandate that providers maintain a state-approved complication plan and carry specialized insurance.
Planned Parenthood officials testified that those rules continue to prevent medication abortions from being offered in Missouri, despite the 2024 amendment.
“All these laws target abortion in a unique way — and also an unconstitutional way,” said Vanessa Pai-Thompson, an attorney with Planned Parenthood Federation of America.
Peter Donohue, deputy solicitor general for Missouri, argued that Planned Parenthood had not met the legal standard to overturn the remaining regulations. He defended the laws as protections against unsafe providers, accusing abortion clinics of a history “fraught with harm to women.”
Evidence presented at trial showed that Missouri women have continued to seek abortions out of state. Over the past decade, more than 53,000 Missourians traveled to Illinois or Kansas for abortion care, according to state and regional health data.
Planned Parenthood officials pointed to that same data to argue the procedure is safe. They testified that the complication rate among those patients remained consistently low — about 1% — with no recorded cases requiring emergency transport from a clinic to a hospital.
“If they’re safe,” Donohue said, “these requirements don’t burden them.”
Planned Parenthood rejected that argument, saying the remaining rules do not improve safety and instead function as barriers to care.
The state was the only party to call women to testify about their abortion experiences. Most said they regretted having abortions. The state also relied on expert witnesses who oppose abortion — testimony that Pai-Thompson later described as advocacy rather than objective medical evidence.
Missourians could also weigh in again at the ballot box. Supporters are pushing a proposed constitutional amendment — often called the “Prohibit Abortion and Gender Transition” measure — that would repeal the 2024 abortion protections. The proposal is still in the signature-gathering and certification process for the November ballot.
Zhang is expected to rule in the case in the coming months.
Dr. Margaret Baum, chief medical officer for Planned Parenthood Great Rivers, testified that if the remaining abortion regulations are struck down, women would be able to access care earlier in pregnancy and closer to home.
Sylvester Brown Jr. is the Deaconess Foundation Community Advocacy Fellow.