Missouri has one of the nation’s strictest abortion bans. Now it’s up to voters to decide whether to keep it

By Lauren Mascarenhas, CNN

(CNN) — Missouri voters this election will decide whether to effectively undo their state’s near-total abortion ban – one of the nation’s strictest – with a ballot measure that aims to write reproductive freedoms into the state’s constitution.

It is one of 10 states voting on constitutional amendments to protect reproductive rights this election – and one of five that could see its vote overturn an abortion ban or restrictive abortion policy.

If passed, the Missouri ballot measure would establish the right to make reproductive care decisions – including about abortion – without interference up to fetal viability, around 22 to 24 weeks into pregnancy.

When the Supreme Court overturned Roe v. Wade in 2022, ending the national right to an abortion, Missouri was the first state in the nation to implement an abortion ban. With no exceptions for survivors of rape or incest, it is one of the nation’s most restrictive abortion laws.

Missouri’s law outlines an exception for medical emergencies, but not fetal anomalies or other pregnancy complications. It also places abortion providers at risk of legal liability.

“For as long as I can remember, I wanted to be a mom. I’m lucky to have my son, but I wasn’t lucky with my second pregnancy,” a woman referred to only as “Erika,” from Kansas City, Missouri, says in a campaign ad in favor of the measure.

“There was a fetal anomaly and to protect myself I needed an abortion, but with Missouri’s total abortion ban, I wasn’t able to get the care I needed in Missouri. Instead, I faced cruel and inhumane barriers.”

Personal stories from women and doctors impacted by the ban have been central to the campaign to get the measure passed, says Erin Schrimpf, a spokesperson for Missourians for Constitutional Freedom, the group backing the measure.

“Those stories really resonate,” said Schrimpf. “We’re really focused on knocking on doors in these last few days. We’ve had over 2,500 volunteers since the start of petition gathering.”

Some of those volunteers have been doctors who are frustrated by the restrictions the state’s abortion policy has placed on them, Schrimpf said.

Because the measure specifically cites the right for people to make their own decisions about contraceptives, access to birth control is also on the ballot.

“When we were drafting the language, we did try to be thoughtful about areas in which the legislature has overreached in the past, or we anticipate may be in the future,” said Emily Wales, president and CEO of Planned Parenthood Great Plains. “If you are a pregnant person or you want contraception in Missouri, we want you to be protected by the state’s constitution.”

The effort faced plenty of opposition, including from state leaders who have brought several legal challenges against the measure aimed at keeping it off the ballot.

In a final ruling in September, state Supreme Court judges ordered Republican Secretary of State Jay Ashcroft to put the measure back on the ballot and to “take all steps necessary to ensure that it is on said ballot,” the Associated Press reported.

Ashcroft, who campaigned on an anti-abortion rights stance in his unsuccessful gubernatorial run, said he will “always fight to protect Life.”

The pushback from anti-abortion leaders may have been a blessing in disguise, says Emily Wales, president and CEO of Planned Parenthood Great Plains.

“The one thing about having politicians who try to subvert direct democracy is that people were fired up,” she told CNN. “It hasn’t felt like a challenge to us to get people to mobilize and get excited.”

When could voters see the abortion ban overturned?

If Missourians vote to approve the measure, it will take 30 days for the constitutional amendment to take effect, and then legal challenges need to be brought against the state’s current ban and prior abortion restrictions, Wales said.

The abortion ban has driven many doctors out of state, and as one of the last remaining abortion providers, Planned Parenthood intends to participate in litigation to repeal the state’s ban if the measure passes, Wales said.

“The 30-day window does give us the time to quickly begin the litigation process, and we will be explaining to the court immediately how the harm is impacting Missourians today,” Wales said. “I anticipate that it will be a few months before we’re able to reestablish abortion care.”

A legal challenge against the existing ban should be straightforward, according to Jamille Fields Allsbrook, an assistant professor at the Saint Louis University Center for Health Law Studies.

“If this constitutional amendment passes, the language is very clear that the intent is to allow abortion in the state of Missouri, and so a judge would have to really be reaching to say that somehow that language is not clear,” she said.

In the meantime, proponents of the measure say they’re confident they have voter sentiment on their side.

“It will be frustrating for Missourians who will feel like they voted, they had their voices heard, and it’s not an immediate change, but change is coming, and it will be sooner than you think,” Wales said.

The final push to get out the vote

For residents in Missouri, along with Arizona, Florida, Nebraska and South Dakota, where voters also have the opportunity to overturn their abortion bans or restrictive abortion policies, the stakes are high.

States with abortion bans have seen providers flee out of state and abortion clinics shutter. It will take work to restore access to those areas, even if abortion bans are overturned, Allsbrook said.

“You have the practical issue of opening clinics back up, and then you have to get those providers and patients back,” Allsbrook said. “So we’re talking about a long time, unfortunately, before we even get things back to where they were in 2022.”

But organizers in these states are hoping voters won’t feel intimidated, said Dawn Penich, communications director for Arizona for Abortion Access, the group backing the state’s abortion rights measure. She and other proponents are out making their final appeal to voters this week.

“We are on everyone’s televisions, we are on their streaming devices, we are in their mailboxes and at their doors,” Penich said.

Change in states with abortion bans won’t come overnight, she said, but for residents in these states, the first step is simple: vote.

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