Abortion back on the ballot in Missouri: Voters decide Amendment 3 on November 3

Just two years after Missouri voters approved an amendment enshrining the right to reproductive freedom, which also protected abortion, in the state constitution, abortion is on the ballot there again. On November 3, Missouri residents will vote on Amendment 3, only this time it would prohibit abortion except in cases of medical emergencies, fetal anomalies, rape or incest.

If the abortion is due to rape or incest, the procedure must occur no later than 12 weeks' gestation, the proposal says. If approved, the amendment would repeal the 2024 amendment that granted reproductive freedom, including abortion through fetal viability, which is typically between 24 and 26 weeks' gestation.

Since Roe v. Wade was overruled by the Supreme Court in June 2022, Missouri enacted a trigger ban prohibiting most abortions in the state. According to an ABC News tally, 13 states have ceased nearly all abortion services while four states have a six-week ban on the books since that decision.

In November 2024, Missouri became the first state to overturn a near-total abortion ban through a direct vote of the people, passing Amendment 3 — the same name as the upcoming ballot measure — with about 52% of the vote.

Mallory Schwarz, executive director of the nonprofit Abortion Action Missouri, told ABC News that Missourians have access to abortion care because the people made it possible. But not even months after the 2024 vote, politicians started plotting to overturn the will of the people, and now voters will have to vote again in a couple of weeks to protect the right that was previously enshrined in the constitution, she said.

State Senator Adam Schnelting, who sponsored the proposal that led to Amendment 3 being placed on this year's ballot, told ABC News that passing the amendment is critical to protecting women and children and providing Missourians with a measure more in line with their values than the one narrowly passed two years ago.

If approved, the amendment would also permit state lawmakers to enact legislation to regulate abortions and access to care. Examples include laws requiring physicians providing abortion care to have admitting privileges at a nearby hospital and licensing requirements for abortion facilities.

The amendment would also prohibit gender-affirming care procedures, cross-sex hormones or puberty-blocking drugs for minors. However, gender-affirming surgeries and medical treatments for minors are already illegal in Missouri under statutory law. Schnelting said that statutory ban expires in 2027 and including the language in Amendment 3 would ensure such a ban is permanent.

Opponents have argued that including language about gender-affirming care is an attempt to mask the parts of the amendment that would limit abortion care. Tori Schafer, director of the ACLU of Missouri, told ABC News that politicians are trying to mislead voters and overturn the will of the people and ban abortion again, and have shown they are willing to resort to tricky tactics. Schafer said organizations supporting Amendment 3 do not use the word abortion in their ads because they know abortion care is popular in Missouri.

After the trigger ban was passed in Missouri in 2022, the state's last abortion clinic in St. Louis was forced to stop providing such care. In 2023 alone, more than 12,000 Missouri women traveled to neighboring states, including Illinois and Kansas, to receive care, according to the Guttmacher Institute. In 2025, more than 3,000 Missourians obtained medication abortions through telehealth from out-of-state clinicians, nearly four times higher than two years prior, the institute said.