Pro-life Missouri on trial

For 10 days last month, pro-lifers and abortion supporters filed into a courtroom in Jackson County, Mo., to watch a trial in which lawyers picked apart dozens of state laws. There, attorneys representing Planned Parenthood and the state dissected pro-life laws that address everything from informed consent requirements to abortion facility maintenance and safety standards.

“There’s somewhere north of 170 laws that are on the books,” Missouri Attorney General Catherine Hanaway told WORLD. “Having to go through and defend a high percentage of those one by one required expert testimony and the testimony of women who had been victims of failure to adhere to these laws.”

Most of Missouri’s pro-life protections are temporarily blocked as the court considers which, if any, the state can enforce. The state argues that the laws protect women from coercion and dangerous procedures, while abortion supporters say the laws defy a 2024 pro-abortion constitutional amendment. Meanwhile, pro-lifers in the once-stalwart pro-life state are looking ahead to the November election and drumming up support for a constitutional amendment of their own.

After the Supreme Court handed down its Dobbs v. Jackson Women’s Health Organization decision that overturned Roe v. Wade in 2022, Missouri was the first state to put into effect its law protecting nearly all unborn babies. But in November 2024, just over 51% of Missouri voters approved an amendment to the state constitution that said the government could not “infringe” on what it called a person’s “right to make and carry out decisions about all matters relating to reproductive health care.” The restriction includes prenatal care, childbirth, and abortion. Under Amendment 3, lawmakers cannot pass laws to protect unborn babies until after viability, and even then exceptions exist for a woman’s mental and physical health.

Planned Parenthood Federation of America and the American Civil Liberties Union sued the state one day after Amendment 3 passed. They argued Missouri must scrap pro-life laws that were in effect before the vote, claiming they clash with the amendment.

While the Dobbs decision put into effect a 2019 Missouri “trigger” law prewritten to protect babies in nearly all cases, other Missouri laws that require women to receive counseling, an ultrasound, and wait 72 hours before obtaining an abortion were already in force before the ruling. But since Amendment 3 passed, nearly all of those protective laws are on hold. Surgical abortions have resumed in the once pro-life state.

Attorney General Hanaway says those laws survived earlier court challenges because they protect women. “There were a number of health and safety regulations that were defended in court and found to be constitutional,” she said of the pre-Dobbs legislation.

The measures required abortion facilities to be licensed by the Department of Health and Senior Services, have annual, unannounced inspections, and include hallways wide enough to accommodate a gurney in case of emergency. They also required abortionists to be licensed physicians, maintain admitting privileges and a transfer agreement with a nearby hospital, and report complications.

According to the state, the pro-abortion amendment should not change the laws’ constitutionality because they already withstood a legal test even while Roe v. Wade was still the law of the land. The state argues that the laws hold abortion facilities to commonsense medical standards and ensure women can give full informed consent before having an abortion. Pro-abortion advocates call these measures “targeted regulation of abortion providers,” or TRAP laws, and claim they place more scrutiny on abortion facilities than other medical centers.

Sam Lee, director of Campaign Life Missouri, said abortion facilities are subject to similar regulations and safety requirements as other outpatient surgical centers. “Their argument is that they as the abortion provider should get to decide what is safe and what is not safe,” he said.

During the trial in Jackson County, Planned Parenthood’s witnesses claimed abortions are safe and rarely cause complications, while several state witnesses said that complications are significantly underreported. The attorney general’s office tried unsuccessfully to subpoena Planned Parenthood’s reports about adverse events.

Longtime pro-lifers Eben and Annie Fowler from the Kansas City area attended several days of the trial over the state laws. “We call them protections, they call them restrictions,” Eben Fowler said.

During the proceedings, the judge heard testimony from medical professionals, abortionists, medical ethicists, former state employees, and women who regretted having an abortion. “One of the glaring omissions on the part of the Planned Parenthood testimony and arguments was that they did not have one happily satisfied woman who had experienced an abortion. Not one,” said Annie Fowler, who works with a local 40 Days for Life pro-life campaign.

Jackson County Circuit Judge Jerri Zhang in July temporarily blocked most of the challenged pro-life laws while the case continued but left in place two laws protecting against chemical abortions. One law requires abortionists to see a woman in person before dispensing abortion drugs, and another requires abortion businesses to have a state health department-approved complication plan for the drugs. Hanaway and her predecessor Andrew Bailey also filed federal lawsuits challenging the recent federal approval of a generic version of mifepristone and Planned Parenthood’s alleged misrepresentations of the drug’s dangers.

It will likely be months before the judge will hand down her decision in the current case. Hanaway said she is doubtful the state will receive a favorable ruling, and she thinks the case will ultimately make its way to the state Supreme Court. She pointed to one promising development from last fall. In October, the Jackson County Circuit Court dismissed a lawsuit challenging the state’s law that requires parental consent for minors to obtain an abortion, effectively upholding that pro-life law.

In the meantime, Missouri voters this fall will once again consider a constitutional amendment involving abortion, but this time that ballot item would repeal the 2024 amendment. The measure would protect babies after 12 weeks of gestation in cases of rape or incest and throughout pregnancy except in medical emergencies that threaten the life of the mother.

“It would put in there a regulation of abortion but allow for what everyone calls hard case exceptions,” said Lee. “It gives women a right to sue for medical malpractice if they’re injured, but it also gives them a right to get care for miscarriages and ectopic pregnancies.”

Lee said pro-abortion groups campaigning for Amendment 3 in 2024 falsely claimed that the state’s pro-life laws would prohibit women from receiving treatment for these conditions. The new amendment, also called Amendment 3, explicitly protects these treatments, though Lee says they were never threatened by the state’s laws.

Voters this year will also consider Amendment 4, which would require all eight congressional districts to approve citizen-initiated constitutional amendments instead of a simple statewide majority of voters.

“The old Amendment 3 only passed in three of the eight congressional districts, so it never would have gone into effect if this proposal was there,” Lee said. Only the districts that contain or are near the major cities of Kansas City, Columbia, and St. Louis voted in favor of the abortion amendment. The rest of the state voted against it.

While it is unclear whether the new Amendment 3 would automatically reinstate any pro-life laws the judge chooses to throw out, Lee said he hopes pro-life voters will turn out to the polls even though there are no major statewide or national candidates on the ballot. “It’s a question of whether you can convince people that they need to come out and vote on this particular issue and vote the right way,” he said. “This is about women’s health and safety, not just about abortion.”