KANSAS CITY, Mo. — Before Missouri became the first state in the country to overturn a near-total abortion ban in 2024, Republican lawmakers were already signaling a plan to strike down the results.

“People will be given an opportunity to vote again,” Sen. Mary Elizabeth Coleman, an Arnold Republican, said before nearly 52% of voters enshrined abortion rights in the state Constitution.

Republican lawmakers followed through with that promise and last year placed a new abortion ban on the Nov. 3 ballot. The proposal, called Amendment 3, would strike down the historic 2024 amendment that legalized access to the procedure.

The upcoming vote has solidified Missouri as a key testing ground in the national fight over abortion rights.

The first state to ban abortion after the fall of Roe v. Wade in 2022, Missouri made history two years later when its voters struck down the ban. Now, the state could be the first in the nation to decide at the ballot box whether its own voter-approved protections should remain in place.

“There haven’t been any states that have passed reproductive freedom amendments like this that have ... you know, undone them — so that would definitely be a first,” said Mary Ziegler, a law professor at the University of California, Davis, who closely follows fights over abortion access.

Abortion rights supporters and opponents are both gearing up for yet another whiplash decision over whether access to the procedure can remain legal.

The measure would only allow abortions in medical emergencies and rape and incest prior to 12 weeks in a pregnancy, a proposal that would outlaw nearly all abortions in the state.

The winding path to Amendment 3

The proposed ban takes aim at the 2024 amendment that allowed abortion clinics to reopen in Missouri — and shares the same name as that measure.

The 2024 vote to legalize abortion in conservative Missouri was historic, offering a sharp rebuke of Republican lawmakers who had spent decades restricting the procedure. Before the 2022 near-total ban, a patchwork of laws had whittled down access to just one clinic by 2019.

In the wake of the 2024 election, abortion opponents repeatedly argued that Missourians did not understand what they were voting on when they approved the measure. During the following legislative session, after weeks of behind-the-scenes wrangling, Republican lawmakers settled on a plan to overturn the results.

“The Republican majority is a pro-life majority,” House Majority Leader Alex Riley, a Springfield Republican, said at the time. “We wanted to work together with our House colleagues, with our Senate colleagues, to come up with another question to put in front of the voters.”

In May 2025, Republicans in the Missouri Senate shut down a Democratic filibuster in an explosive vote that placed the proposed ban on the Nov. 3 ballot.

In a move designed to attract more voters, lawmakers also attached language that would place a ban on gender-affirming care for minors in the Missouri Constitution. Those procedures are already banned under a 2023 state law.

Supporters emphasize that the 2023 law’s ban on puberty blockers and hormone therapy is set to expire next year. But the ban on surgeries, a frequent focus for Republicans and the campaign, does not expire.

Abortion opponents, supporters gear up

Recent polling suggests that Missouri could be headed toward another close vote on abortion.

In August, a Saint Louis University and YouGov poll found that 44% of respondents opposed the ballot measure while 43% supported it. The remaining 13% said they were not sure, illustrating a significant percentage of undecided voters.

The main campaign opposing the amendment, NO on 3, Stop the Ban Missouri, is made up of the same coalition that successfully legalized abortion in 2024. The group includes the ACLU of Missouri, Abortion Action Missouri and the Planned Parenthood affiliates in Kansas City and St. Louis.

The opposition campaign has accused amendment supporters of attempting to trick voters into banning abortion again. Abortion rights groups largely point to the fact that the proposal would ban nearly all abortions in the state.

Tom Bastian, the group’s spokesperson, said in a statement that “politicians have shown complete disregard to the will of voters” since the 2024 vote to legalize access.

“Amendment 3 is the culmination of two years of politicians plotting how they could overturn the will of voters and ban abortion,” Bastian said. “While politicians refuse to say what Amendment 3 will actually do, Missourians see through their lies and will vote NO to stop the abortion ban.”

Last week, the campaign promoted a letter from more than 470 doctors and medical professionals who urged voters to reject the amendment.

The main campaign in favor of the amendment, called Her Health, Her Future, is backed by the Missouri Republican Party and a slew of Republican lawmakers. Missouri first lady Claudia Kehoe is the PAC’s treasurer.

“There has never been a more critical vote for the protection of Missouri women and children than Amendment 3,” Amanda Sanders, the campaign’s spokesperson, said in a statement. “The destruction of pro-women’s health laws and allowing abortion clinics to police themselves are not what Missourians voted for in 2024.”

Sanders added that the measure would end “extreme late-term abortion” and reiterated the argument that it would ban gender-affirming care for minors. Missouri is one of 18 states that legalizes abortion at or near fetal viability, according to KFF, a national health policy organization that tracks state-level abortion laws.

The campaign has largely downplayed the amendment’s impact on abortion. In TV ads, on signs and on its website, the campaign has focused heavily on the gender-affirming care language attached to the measure.

For example, the campaign’s bio on social media makes no mention of abortion and promises to “end sex change surgeries for minors,” which are already permanently banned in Missouri.

On Tuesday, the campaign held a rally in Arnold featuring two prominent activists who have fought against health care for transgender minors.

After leaving the FBI, former Attorney General Andrew Bailey filed paperwork earlier this month to launch a new group supporting the amendment. The group, called Vote Yes on Amendment 3, is also affiliated with Republican U.S. Sen. Josh Hawley.

High-stakes vote looms

As Missouri voters prepare to decide the fate of abortion rights next week, the high-stakes vote is poised to reverberate across the state for years.

If the amendment fails, Missouri Republicans will likely look for new ways to limit access, including court challenges and attempts to enact more modest changes to the procedure, said Ziegler, the law professor.

If it passes, Missourians would once again be living under a strict abortion ban, similar to Texas, Ziegler said.

Missouri Republicans’ decision to attach gender-affirming care language to the measure could also serve as a playbook for other states looking to ban abortion.

“I’ve heard that the polling is really close in Missouri and, I mean, that’s not surprising because it was really close last time,” she said. “I think it’s really going to be down to the wire.”

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