Missouri judge finds state laws restricting abortion violate voter-approved constitutional amendment

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A Missouri judge this week struck down a series of restrictions on abortion, finding they violated a constitutional amendment that voters approved in 2024.

Many of the provisions were already on hold because of an earlier, preliminary court ruling. But it is resulting in one major change: The state's Planned Parenthood affiliates say the new ruling means they're going to start prescribing abortion pills to patients there for the first time since 2018.

The ruling is a clear legal victory for abortion rights advocates, but it's not the final word. An appeal and another ballot measure are on tap.

Jackson County Circuit Judge Jerri Zhang's ruling Thursday came months after she held a 10-day trial on the issue earlier this year.

She ruled on whether 40 different state laws conflicted with the 2024 amendment. In most cases, she sided with abortion rights groups — and against the state government, which was arguing that the laws should be enforced.

She overturned a number of provisions including a requirement that women seeking an abortion see a doctor in person twice at least 72 hours apart, and another requirement that the initial dose of abortion pills, which are the most common way abortions are obtained, be taken in the presence of the prescribing doctor.

But she didn't throw out a requirement that patients see a doctor in-person to confirm gestational age and rule out an ectopic pregnancy.

Missouri was the first state to enforce a ban on abortions at all stages of pregnancy after a U.S. Supreme Court ruling in 2022 overturned Roe v. Wade.

Even before the ban went into effect, other laws already on the books meant that abortion was not readily available for many women in the state.

In 2024, the state's voters made it the first to adopt a constitutional amendment to undo a ban, allowing abortion until fetal viability, which is generally considered to be somewhere past 21 weeks into a pregnancy, though there’s no fixed time frame. The two Planned Parenthood affiliates that operate in the state sued to undo abortion restrictions immediately after voters approved that state constitutional amendment.

After this week's ruling, Planned Parenthood said it would offer appointments starting next week for medication abortion.

“For too long, politicians forced patients to leave the state for an evidence-based and trusted form of abortion care,” Emily Wales, president and CEO of Comprehensive Health of Planned Parenthood Great Plains said in a statement. “Now, that care is coming home and with it, we move closer to fulfilling the promise of reproductive freedom Missourians demanded.”

The ruling also affirmed that the clinics could continue to offer abortion procedures.

Two different surveys of providers conducted for groups that support abortion rights — the Guttmacher Institute and the Society of Family Planning — estimated that in the second half of 2025, somewhere around 300 abortions each month were provided in Missouri. Those were from providers in other states that prescribe and send abortion pills to women in states with abortion bans or restrictions. Those providers are in states with laws that week to protect prescribers from legal action in states with bans — another issue that's being contested in court.

Guttmacher found that in 2024, Missouri women traveled to bordering Illinois and Kansas for about 12,000 abortions.

Attorney General Catherine Hanaway said she will appeal this week's ruling.

“This is exactly the Pandora’s box we warned of, and the women of Missouri will pay the price,” Hanaway said in a statement.

Abortion will also be on the ballot again in November, when voters are being asked to approve a measure that would undo the 2024 amendment.