An abortion procedure room pictured on March 3, 2025, at Planned Parenthood in Columbia (Anna Spoerre/Missouri Independent).After Missouri banned nearly all abortions in 2022, Valerie Weaver began noticing a troubling change in some of the pregnant patients she cared for in Kansas City.
They were arriving to her sicker. Some had developed infections, blood clots or other complications while waiting for treatment. Some were so ill they required general anesthesia rather than an epidural or spinal, increasing the risks of their care.
Weaver, a certified registered nurse anesthetist with a doctorate in nursing practice who cares for high-risk obstetric patients, said the problem was particularly acute in situations such as a woman’s water breaking before her fetus could survive outside the womb.
“That law made it so where we couldn’t care for the mother until she had an active threat against her life,” she said.
In 2024, Missouri became the first state to overturn an abortion ban at the ballot box. Weaver said her patients now have a choice they lacked under the ban: End a pregnancy before an emergency develops, even if there is still a fetal heartbeat, or continue the pregnancy.
But Weaver fears those conditions could return after the Nov. 3 election.
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Amendment 3 would repeal the reproductive rights amendment Missouri voters approved in 2024 and reinstate an abortion ban with exceptions for medical emergencies, as well as certain fetal anomalies and pregnancies resulting from rape or incest within the first 12 weeks. It would also enact a constitutional ban on gender-affirming care for minors, which is already banned in state statute.
Supporters insist those exceptions would protect women who need abortions.
But some physicians, attorneys and patients who experienced Missouri’s previous ban say the exceptions could prove difficult to implement in practice, leaving doctors uncertain about when they can intervene.
Medical emergencies and fetal anomalies
The first TV ad for Stop the Ban, the campaign to defeat Amendment 3, features a Missouri mother who faced a dangerous pregnancy complication.
“I needed an abortion to save my life,” she said. “And now politicians are trying to take that right away from us.”
Missouri Attorney General Catherine Hanaway in a recent interview hosted by the Family Research Council, a conservative nonprofit, called the No on 3 campaign messaging “a flat out lie.”
Dr. Sarah Florence, a board-certified family medicine physician from Fenton who spoke in support of the amendment at the Midwest March for Life in April, said the language isn’t written to sacrifice women’s health.
“Sometimes the mother must be separated from the baby in order for her life to be saved, and sometimes for the baby’s life to be saved as well,” she told The Independent this week. “ But that never, ever, in medicine, requires the additional step of intentionally killing the child first.”
Stickers saying “repeal and replace Amendment 3,” referencing the 2024 abortion rights amendment, are distributed during Missouri Right to Life advocacy day at the Missouri State Capitol on March 26, 2025 (Annelise Hanshaw/Missouri Independent).
Molly Duane, litigation director at Amplify Legal, the litigation arm of Abortion in America, said cases in other states show why exceptions likely not work as supporters intend. Duane represents women in several states who she said were denied or delayed lifesaving pregnancy care because of an abortion ban.
The proposed language in Amendment 3, Duane said, “is an absolute disaster zone.”
“It has all of the problems that the abortion bans in other states where I have litigated have that have caused people to be denied care for ectopic pregnancy, miscarriages, fatal fetal diagnoses, conditions like pre-eclampsia, water breaking prematurely, bleeding and septic infections,” she said. “It has all of those problems, plus more.”
For example, she said, Amendment 3 defines a fetal anomaly as a “structural or functional abnormality in the unborn child’s gestational development that would make life outside the womb impossible.” The use of the word “impossible,” Duane believes, would exclude many devastating anomalies, because in most cases the infant could be born alive, but die soon after.
Florence, when asked about this language, said doctors can’t see into the future to know how a pregnancy will progress.
“I am confident that there are doctors that don’t hesitate to talk about a congenital abnormality being incompatible with life,” she said. “And that’s used to justify abortion.”
‘Cruel and inhumane barriers to healthcare’
Erika found out she was pregnant with her second child in November 2022, months into Missouri’s near-total abortion ban. She agreed to speak to The Independent on the condition that she be identified by her first name, citing concerns for her privacy and the charged political climate around abortion in Missouri.
On a trip to Disneyland, Erika, her husband and her toddler posed with the ultrasound photos next to Lightning McQueen. She thought up the perfect caption for a post about her pregnancy: “Ka-Chow! Not all kicks come from Route 66.”
But she never made the announcement.
A few days later, at Erika’s 20-week anatomy scan, she learned her son, who she named Easton, had a rare fetal anomaly.
“I’m going to be honest, it’s not good,” she recalls her doctor saying. “But I’m going to take care of you.”
But her doctor later determined she could not provide an abortion in Missouri without risking prosecution. Erika and her husband eventually flew to a hospital in Washington, D.C.
There, she had an abortion. After she delivered her son’s body, she held him.
“I didn’t have to watch him suffer and suffocate to death,” Erika said. “He was able to be given the compassion and the dignity that I believe he deserved.”
After Missouri passed the reproductive rights amendment, Erika and her husband decided to try again. Her doctor reassured her that if anything went wrong this time, she could get care without leaving the state.
“Amendment 3 is incredibly personal to me,” she said from her Kansas City home, where she recently brought home her infant daughter. “Stopping this abortion ban means that future families won’t experience the cruel and inhumane barriers to healthcare that I did.”
Rape and incest exceptions
Amendment 3 would allow abortions in cases of rape or incest for survivors who end their pregnancy within 12 weeks.
Lawmakers removed a proposed police-reporting requirement before placing the measure on the ballot.
Julie Donelon, president and CEO of the Metropolitan Organization to Counter Sexual Assault, has concerns with the 12-week deadline. It often isn’t long enough for survivors to discover they’re pregnant, process the trauma of the assault, and then seek out care, she said.
“We know that providers won’t be readily available,” Donelon said. “That could really push that deadline of the 12 weeks exception for rape and incest survivors.”
Right now, Donelon said MOCSA points any survivors who are pregnant and want information on options to Planned Parenthood, not hospitals.
Last year, all 46 abortions performed in Missouri hospitals were listed as medical emergencies, meaning none were elective, according to data from the Missouri Department of Health and Senior Services.
Susan Frelich Appleton, a professor at Washington University School of Law who also serves as a member emerita of the board of directors of Planned Parenthood Great Rivers, believes abortion would become virtually non-existent under Amendment 3, including for survivors.
“How does a provider determine that the pregnancy resulted from rape or incest? As we see from recent news stories, it’s often not a clear-cut matter,” she said. “It’s such a judgment call that it would be very risky to hang your hat on the rape and incest exception.”
Amanda Sanders, a spokeswoman with the Yes on 3 campaign, said Amendment 3 explicitly carves out protections for survivors while also regulating the providers who would care for them.
“None of this is about delay,” Sanders said. “This is about what happens to a woman if something goes wrong.”
Subhead: Would abortion providers remain open?
By May 2022, the month before the U.S. Supreme Court overturned Roe v. Wade and Missouri enacted an abortion ban, only one Planned Parenthood clinic in the state was still offering abortion. The rest stopped providing the procedure following decades of regulations enacted by the legislature that they said made it impossible to do their jobs.
Sanders said the 2024 amendment left Missouri as the “wild west of abortions,” pointing to dozens of abortion regulations that were struck down as unconstitutional under the reproductive rights amendment.
“An abortion clinic that has no oversight is a back alley abortion,” she said. “And so that’s what we have right now under the status quo.”
Amendment 3, she said, restores “common sense” regulations.
After the 2024 reproductive rights amendment passed, Planned Parenthood and the ACLU of Missouri sued the state, arguing that about 40 of these statutes and regulations on the books in Missouri were unconstitutional because they created obstacles to care without making procedures safer.
In June, Jackson County Judge Jerri Zhang struck down dozens of regulations, including a 72-hour waiting period, special licensing requirements for abortion providers and hospital admitting privileges. She upheld a requirement that medication abortion be administered in person, and that only doctors can perform abortions or prescribe medication abortion.
Zhang wrote in her order that several safeguards remain in place even absent of all the regulations set by the legislature.
The ruling is under appeal. If Amendment 3 passes, it would take effect 30 days after the election.
Michael Wolff, a former chief justice of the Missouri Supreme Court and dean emeritus at Saint Louis University School of Law who was featured in a TV ad opposing Amendment 3, expects the court orders blocking the old abortion restrictions to fall away. That could leave Planned Parenthood providers unable to offer even abortions allowed under the exceptions.
The Missouri Attorney Generals Office in a statement said Amendment 3 would affect the ongoing litigation between Planned Parenthood and the state, “likely to the benefit of Missouri’s existing health and safety regulations.”
Dr. Jennifer Smith, an OB-GYN in St. Louis, addresses abortion rights advocates gather for a canvassing kick-off event on Aug. 29 in St. Louis County (Anna Spoerre/Missouri Independent).
Dr. Jennifer Smith, a St. Louis OB-GYN who is campaigning with Stop the Ban, said patients who qualify for an exception could still struggle to get care at hospitals, especially if the procedure isn’t covered by insurance. Planned Parenthood clinics have partnerships with abortion funds that help cover costs for patients.
“We need Planned Parenthood to be functioning, because people can’t get this care in their hospital,” Smith said.
It’s unclear what services Planned Parenthood could provide under Amendment 3. In a brief statement, Missouri’s Planned Parenthood affiliates said Amendment 3 would “force women to leave the state to receive basic care.”
“As a practical matter,” Wolff said, “if I were advising the abortion providers, they would have to stop.”
