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After Missouri residents voted to repeal their state’s near-total abortion ban and enshrine abortion rights into their state constitution, advocates quickly got to work. In a lawsuit filed the day after the 2024 election, abortion providers challenged not only the constitutionality of the state’s ban, but also a slew of other restrictions that, they said, made their jobs so arduous as to be impossible.
More than a year later, they’re still in court.
On Monday, Missouri abortion rights supporters and opponents ended a two-week-trial over the legality of dozens of Missouri restrictions. But Missouri is far from the only state where activists are waiting to realize the full promise of ballot measures that were meant to expand abortion rights in states that passed them. Legal battles over the measures are also raging in Arizona, Michigan, Montana, Nevada and Ohio. In some of these states, lawmakers have also introduced legislation that, experts say, would undercut the will of voters who passed the measures.
At least three states are set to vote on pro-abortion-rights ballot measures come November. Advocates hope they’ll join the 12 states that passed such measures after the fall of Roe v Wade, which triggered a national backlash that highlighted how popular abortion protections are even in red states. But abortion rights supporters are warning that the fights that have followed prove that such measures are not a panacea, given the obstacles that decision-makers can throw up.
“A ballot measure changes the constitution and it says that the voters want receptive rights and freedom to be protected, but the amendments don’t make everything go away on their own,” said Amy Myrick, senior counsel at the Center for Reproductive Rights, which is involved in several post-measure legal battles. “The courts and the legislatures have to follow through to strike down restrictions when they’re unconstitutional. And even when there’s a right in the constitution, burdensome restrictions can stay on the books and make it difficult or even impossible for people to get care.”
While advocates have successfully used the measures to strike down sweeping abortion bans, they hoped to use the measures to also eliminate the hundreds of restrictions that had gnawed away at access to abortion in the decades before the US supreme court overturned Roe v Wade. Missouri’s history, in particular, offers a snapshot of these restrictions’ power. Onerous rules around abortion clinics’ operation – such as a requirement that providers perform two pelvic exams on patients – nearly forced the state’s last abortion clinic to close in 2019. The number of abortions performed in Missouri plunged: Just 167 abortions were recorded in 2020. That marked a 97% decrease from 2010, far more than the national average.
During the trial earlier this month, Missouri abortion providers argued that the measure rendered many of the state’s restrictions unconstitutional . Among the restrictions they hope to remove are a ban on prescribing abortion pills through telehealth, a requirement that physicians develop an in-depth complications plan and a mandate that abortion patients wait 72 hours after an initial consultation before undergoing the procedure.
These laws, they argued, constituted “targeted regulations of abortion providers” (Trap) laws, leading abortion to be policed unlike any other medical procedure.
“I provide vasectomies routinely,” Dr Margaret Baum, chief medical officer with St Louis-based Planned Parenthood Great Rivers, testified. “And I am not required to have a complication plan, contact a primary care physician, even ask the patient how many miles they live from the health center.”
State officials, meanwhile, maintained that the restrictions are necessary to protect women’s health.
“If they’re safe, these requirements don’t burden them,” Peter Donohue, Missouri’s deputy solicitor general, said in court of abortion providers. A ruling isn’t expected for several months.
‘A snub to the voter’
By 2022, the year that Roe fell, 24 states had enacted Trap laws. States passed most of those laws after 2010, when Republicans – enraged by Barack Obama’s 2008 ascension to the presidency – mounted a nationwide campaign dedicated to retaking state legislatures.
The legal battles outside Missouri are also largely over Trap laws. Earlier this month, Arizona advocates went to trial over a requirement that requires patients to make two in-person trips to an abortion clinic 24 hours apart and a ban on telemedicine abortion (which has become an increasingly common abortion method since Roe’s demise). In Ohio and Michigan, activists are hoping to strike down a similar 24-hour waiting-period law, among other restrictions, while Montana advocates are fighting against 2024 licensing requirements that could force abortion clinics to close. In Nevada, they have sued to strike down a 1985 law that requires minors to notify their parents before getting an abortion.
Conservative legislators in some of these states are also still trying to implement new abortion restrictions. Last year, Ohio lawmakers introduced a bill to strengthen the anti-abortion doctrine of “fetal personhood”, which claims that embryos and fetuses deserve full legal rights and protections, even though 57% of voters supported enshrining abortion rights in the state constitution in 2023. In Montana, where 57% of voters decided in 2024 to codify the right to an abortion up until fetal viability, legislators considered a bill that would ban people from helping others get “illegal” abortions both in and out of the state. (The bill did not explain what constituted an “illegal” abortion.) Both state legislatures are dominated by Republicans, but neither bill became law.
However, the Republican-controlled Arizona statehouse has already advanced three fetal-personhood bills this year. If fully enshrined in law, fetal personhood would make abortion illegal – and fly in the face of the 62% of Arizona voters who, in 2024, voted to protect abortion rights.
Jos Raadschelders, an Ohio State University professor who studies the structure and functioning of governments, called Ohio legislators’ attempts to circumvent their state’s ballot measure “an act of arrogance”.
“Ignoring the will of the voters is democratic backsliding,” he said. “It’s a snub to the voter.”
Even if abortion providers win their case in Missouri, the procedure may not remain accessible for long. Even though 51% of the state’s voters supported the pro-abortion ballot measure in 2024,anti-abortion activists have placed a fresh measure on the 2026 ballot that, if passed, would effectively repeal the 2024 measure and restore the state’s abortion ban.
Mallory Schwarz, executive director of Abortion Access Missouri, called the upcoming measure “disheartening”.
“There was so much back and forth around the ballot, solving everything in one go, but it was never going to be that simple,” she said. “It’s going to take a concerted effort, a multipronged legal organizing advocacy, a grassroots strategy, in order to get Missouri to a point of people being able to exercise the rights they voted for. That’s certainly frustrating.”
