A Missouri judge struck down a broad set of abortion restrictions, ruling that many of the state’s older abortion laws conflict with a voter-approved constitutional amendment protecting reproductive freedom.
In a June 18 ruling in Jackson County Circuit Court, Judge Jerri Zhang issued a final judgment after a 10-day bench trial in Kansas City, finding that several abortion-specific statutes and regulations violate Amendment 3, which voters approved in 2024.
The lawsuit was brought by Planned Parenthood Great Plains and Planned Parenthood Great Rivers-Missouri, challenging roughly 40 statutes and regulations that remained on Missouri’s books after the state’s near-total abortion ban took effect following the U.S. Supreme Court’s 2022 decision overturning Roe v. Wade.
Amendment 3 added a right to reproductive freedom to the Missouri Constitution that protects decisions involving abortion up to fetal viability. The amendment changed the legal standard for abortion regulation in the state.
Under the amendment, the government cannot deny, interfere with, delay, or restrict reproductive freedom unless the state can show a compelling health-related reason and use the least restrictive means to meet that goal. Because the amendment is part of the state constitution, older statutes and regulations cannot be enforced if they conflict with that protection.
The complaint framed the challenged laws as barriers to care rather than ordinary health rules. Planned Parenthood claimed the regulations imposed delays, licensing burdens, and medical requirements that made abortion services difficult or impossible to provide. State officials defended the laws as patient safety measures and argued that removing them would leave abortion without adequate oversight.
The ruling blocks enforcement of several major restrictions, including Missouri’s 72-hour waiting period, special licensing rules for abortion facilities, admitting-privileges requirements for doctors, and state-mandated information patients were required to receive before an abortion.
Zhang also struck down a telemedicine restriction requiring a prescribing physician to be in the same room when a patient takes the first dose of abortion medication, a rule Planned Parenthood claimed prevented remote prescribing and limited a patient’s ability to take the medication at home after medical approval.
Zhang’s decision did not remove every abortion-related rule. The judge upheld a requirement that patients meet with a physician in person before abortion medication is prescribed, to confirm gestational age and rule out an ectopic pregnancy, a potentially dangerous condition in which a fertilized egg implants outside the uterus. The ruling also leaves in place Missouri’s same-physician and physician-only requirements, along with a statute involving interference with medical assistance.
Missouri’s rules for abortions later in pregnancy also remain largely in place, though Zhang struck a provision requiring a second physician to agree that the procedure was necessary.
The order also reached more technical requirements, including a state-approved complication plan for providers prescribing abortion medication, as well as pathology and reporting rules tied to abortion procedures. Missouri’s tail-insurance statute was struck down on separate due process grounds after the court heard testimony about the availability of the type of insurance described in the law. Zhang found the statute too vague to enforce.
Zhang’s ruling drew a distinction between abortion-specific restrictions and medical rules that apply more broadly across health care. The judge noted that Planned Parenthood was not challenging generally applicable requirements, including infection control rules, malpractice insurance laws, mandatory reporting laws, professional licensing systems, and medical ethics standards. The court found that many of the abortion-specific measures did not meet Amendment 3’s standard.
The ruling is expected to have an immediate effect on access to abortion medication in Missouri. Planned Parenthood stated that appointments would begin at clinics in Kansas City and St. Louis, followed by Columbia. The decision restores access to abortion medication in Missouri for the first time since 2018.
Missouri Attorney General Catherine Hanaway said the state plans to appeal the decision to the Missouri Supreme Court. The court’s order states that a $100 bond posted by Planned Parenthood in December 2024 will remain in place pending appeal.
