The battle to determine the real-world impact of Missouri’s reproductive rights amendment reached a pivotal point last week when an appeals court upheld a decision to block enforcement of several laws restricting abortion. The ruling is important because it suggests that efforts to hollow out reproductive rights ballot measures may be rejected even in conservative states.
After the U.S. Supreme Court rejected Roe vs. Wade In 2022, Missouri enacted one of the strictest anti-abortion laws in the nation. But in 2024, Missouri voters passed the Right to Reproductive Freedom Initiative, which created new state constitutional reproductive rights. Planned Parenthood organizations subsequently challenged the state’s abortion ban and restrictions, arguing that they violate the state’s new Reproductive Freedom Amendment. The lawsuit aimed to clear up confusion about the state of the law and allow providers in the state to offer a broader range of services.
last week’s decision Planned Parenthood Comprehensive Health Great Plains v. Missouri., overall health The issue concerned a challenge by family planning organizations to targeted regulations for abortion providers known as the TRAP Act. The measures at issue include requirements that clinics have admitting privileges to hospitals within 15 minutes, adhere to standards governing outpatient surgery centers, perform pelvic exams before every procedure, and require patients to wait 72 hours before a procedure is performed. Planned Parenthood argued that these measures are unconstitutional under the new amendments and sought an injunction to block their enforcement while litigation continues.
In a series of rulings late last year and early this year, Missouri Judge Jerry Chan granted the family planning system’s requests, reasoning that the regulations did not serve the government’s compelling interests and did not use the least restrictive means to achieve the government’s goals. She explained that the reproductive rights amendments make it clear that a government has a compelling interest only when acting for the “limited purpose and with the limited effect of improving or preserving the health” of a person seeking an abortion. Additionally, she determined that some of the requirements were likely to violate the proposed amendments because they singled out abortion as a subject of particularly onerous regulations.
The state then applied directly to the state Supreme Court for a special order, known as a writ of mandamus, to allow the state to continue enforcing the TRAP law. The Supreme Court granted the attorney general’s request, and Zhang explained that the criteria for evaluating whether to grant a preliminary injunction against the law were incorrect. Rather than requiring the family planning system to show that it was likely to succeed on the merits, Zhang considered whether the plaintiff had a fair chance of success. The state Supreme Court instructed Zhang to reconsider whether to grant the injunction based on the new criteria. In July, Zhang again ordered enforcement of the challenged restrictions, applying the correct standard.
This week’s ruling unanimously upheld Zhang’s July ruling. The court began by addressing the state’s procedural arguments, including arguments over whether Planned Parenthood has standing to sue. The court reasoned that Planned Parenthood was clearly at risk under the state regulations because all regulations “impose criminal penalties on abortion providers who violate them.” Additionally, Planned Parenthood had a position arguing that Missouri’s regulations discriminated against abortion providers compared to other health care providers and violated the Abortion Rights Amendment. The court also rejected the state’s argument that there was no living issue for the court to resolve (the standing requirement) because the state had vowed not to enforce some of the provisions at issue during the course of the family planning system’s litigation. The court noted that even these disavowed provisions remained in dispute, as Planned Parenthood argued that these restrictions had no constitutional application, but the Attorney General argued that they may still be enforceable under certain circumstances.
The court next focused on whether Ms. Zhang abused its discretion in granting Planned Parenthood’s request for an injunction. The court said there was no evidence for the state’s argument that the abortion rights amendment “simply limits laws and regulations that directly prohibit or restrict access to abortion.” Rather, it applied to “all statutes and regulations that have the effect of impeding or restricting access to abortion.”
The court further noted that the amendment also prohibits discrimination against abortion providers and services. The court explained that because the challenged regulation applied only to abortions and not to comparable surgical procedures, the burden shifted to the state to prove that the law could be constitutionally applied. The appellate court found that the agreement with Zhang did not indicate whether the state could shoulder that burden at this time, and therefore Zhang did not abuse its discretion to conclude that the challenged restrictions were likely unconstitutional.
Finally, the court rejected the state’s argument that Planned Parenthood could not prove that enforcement of the restrictions challenged during the lawsuit would cause irreparable harm, another requirement for winning a preliminary injunction. The state wanted patients to be able to visit health care providers in other states for abortion services, an argument the court called “disingenuous.” Missouri adopted the Abortion Rights Amendment “so that Missouri residents would not have to travel to another state to obtain abortion care,” the court said.
However, the fight is far from over, as a full-scale trial on the constitutionality of the TRAP law is scheduled for January 2026. Planned Parenthood and the American Civil Liberties Union (ACLU) are also pursuing a separate challenge to state regulations that would prohibit health care providers from offering mifepristone and misoprostol, the drugs used in the majority of abortions nationwide. These cases will likely end up in the Missouri Supreme Court.
Then there’s the question of whether the state constitution will change again. The state’s Republican-controlled Legislature has proposed overturning the 2024 result and allowing voters to consider a new ballot measure in 2026 that would criminalize abortion in all but a few circumstances. The ACLU objected to the proposal’s language, saying it was inaccurate and biased because it did not inform voters that if it passed, abortion would again be a crime in the state. After several failed attempts, the trial judge approved the state’s latest proposed language, which referred to the repeal of “Article 1, Section 36,” a reference to the Reproductive Rights Amendment, without including a descriptive name or saying that abortion is prohibited in nearly all circumstances.
If last year’s amendment bill remains in place, there is a high possibility that the abortion regulation will not be passed. Anti-choice lawmakers in Missouri appear to believe that the best way to restrict access to reproductive health care is to undo voters’ decisions to protect access to abortion by obscuring the true outcome of next year’s anti-abortion ballot measure.
Mary Ziegler is the Martin Luther King Jr. Professor of Law at the University of California, Davis School of Law and the author of the following books: Figures: The new civil war over reproduction.
Recommended Citation: Mary Ziegler, Missouri Court of Appeals upholds order blocking abortion restrictionsSᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (October 20, 2025), https://statecourtreport.org/our-work/analysis-opinion/missouri-appeals-court-upholds-order-blocking-abortion-restrictions
