Abortion rights amendment's passage triggers new legal battle in Missouri

WASHINGTON -- Abortion rights advocates prevailed on seven ballot measures across the U.S. in Tuesday's election and lost on three.

The losses are the first on statewide reproductive rights ballot measures anywhere in the U.S. since the Supreme Court overturned Roe v. Wade in 2022, a ruling that struck down the nearly 50-year nationwide right to abortion, proving that abortion opponents can win on ballot measures.

There were firsts on the other sides, too: Three amendments call for rolling back abortion bans, including one in Missouri that bars it at all stages of pregnancy with exceptions only under limited circumstances to save the life of the woman.

Here's a look at takeaways from the results.

Missouri is the most populous state where a ballot measure could roll back a current ban on abortions at all stages of pregnancy.

But the work isn’t done there.

Planned Parenthood affiliates that operate in Missouri filed in a state court Wednesday seeking to invalidate the state's abortion ban and several laws that regulate the care.

The Missouri amendment, which is to take effect Dec. 5, does not specifically override any state laws. Instead, the measure left it to advocates to ask courts to knock down bans that they believe would now be unconstitutional.

Planned Parenthood leaders said Wednesday on a Zoom call with reporters that they want to start offering abortions at clinics in Columbia, Kansas City and St. Louis if they get the judicial ruling they're requesting — starting with blocking enforcement of laws on the book.

"This is only the first step to realizing and fully implementing the protections of Amendment 3. It’s certainly not the last step,” said Richard Muniz, interim president and CEO of Planned Parenthood Great Rivers.

Clinics had stopped providing abortions in Missouri even before the state’s ban took effect in 2022. They said a list of regulations made it impossible for them to operate. In its legal filing, the Planned Parenthood affiliate that covers much of the state says the onerous requirements include clinicians who provide abortion have surgical licenses and that they conduct pelvic exams on all patients — even if they offer only medication abortions.

“Some of these patients choose medication abortion precisely because they do not want instruments inserted into their vagina,” Dr. Selina Sandoval, an associate medical director for Planned Parenthood Great Plains, said in a legal filing. “I cannot and will not subject my patients to unnecessary exams.”

Planned Parenthood also objects to laws requiring clinicians to have admitting privileges at nearby hospitals, mandating a 72-hour waiting period for abortions and banning telemedicine for abortion. Besides the ban on abortion at all stages of pregnancy, the group is calling for having other bans that kick in after eight, 14, 18 and 20 weeks of pregnancy to be struck down.

Abortion rights advocates heralded victories at the ballot box as a signal of widespread support for abortion rights, even in conservative states.

The three states where abortion measures were defeated had special circumstances that weren't present in the others.

In Florida, the threshold for passing a constitutional amendment is 60% while most states require a simple majority. Most voters supported adding abortion rights — but it fell short of the requirement.

There, Gov. Ron DeSantis, a Republican with a national profile, also presented a challenge to proponents by steering state GOP funds to counter the measure and defending a state agency for publishing a webpage attacking it, among other government efforts.

In South Dakota, the measure is different from the others because it would have allowed the state to regulate abortion in the second trimester — but only in ways that protect the health of the woman. Because of that provision, most national abortion rights groups did not put money into promoting it, which could have been a factor in its failure in a conservative state.

In Nebraska, both sides had questions on the ballot. Voters passed the one that bars abortion after the first 12 weeks of pregnancy — which is in line with current state law — and also allows the possibility of more stringent bans. They also rejected the measure that aimed to enshrine into the state constitution the right to abortion until viability, which is considered to be sometime after 21 weeks of pregnancy, though there's not a fixed time.

Abortion rights advocates condemned the novel strategy by anti-abortion groups of putting a competing measure on the ballot as an attempt to confuse voters. The approach was considered by anti-abortion groups elsewhere.

Republican Donald Trump reclaimed the presidency, despite his consistently shifting stances on reproductive rights.

If Republicans win the House, in addition to their victories in the Senate and White House, it could open the door to the passage of a national ban.

Trump has said he would veto a national ban, despite previously declining to answer questions about it.

But Republicans have been accused of attempting to recast federal abortion restrictions as “minimum national standards” in order to distort their own stances on the issue, given the political unpopularity of the GOP’s position on abortion.

Judicial appointments have already shaped the national abortion landscape. Trump has repeatedly taken credit for appointing three justices to the U.S. Supreme Court who helped form the majority that overturned Roe v. Wade. It's not just the Supreme Court. Trump-nominated U.S. District Judge Matthew Kacsmaryk has issued rulings with nationwide consequences, including one impacting access to the abortion pill mifepristone.

Through executive power, a president could also restrict abortion pills sent through the mail and declare that a law that requires doctors to stabilize emergency room patients does not require them to provide abortion. A new administration could also pull back on a federal lawsuit that challenges aspects of Idaho's ban.

One interpretation of the presence of some of the ballot measures was that they were put up in part to drive turnout of Democratic voters in candidate elections.

If that was the plan — and some abortion rights advocates say it wasn’t — it didn’t seem to sway other statewide races.

The mostly Republican states of Montana and Missouri passed abortion rights protections and also elected GOP candidates for president, U.S. Senate and governor.

In Montana, Republican Tim Sheehy defeated three-term incumbent Sen. Jon Tester, who attempted to pair his campaign with the abortion rights push.

Three other Republican states — Florida, Nebraska and South Dakota — rejected abortion ballot measures and supported Trump for president and GOP senators where they were on the ballot.

The Democratic states of Colorado and Maryland expanded abortion rights and voted for Democrats in statewide elections. The same is true in New York, where the ballot measure bars discrimination on the basis of “pregnancy outcomes” and does not mention abortion specifically — but was championed by abortion rights advocates, who say it will preserve access.

The measures also passed in Arizona and Nevada, where the presidential and U.S. Senate races had not been called by midday Wednesday.

Democrats in the most competitive Senate races centered their closing argument and ads around abortion, an issue they hoped to capitalize on after it has previously motivated voters up and down the ballot. But abortion rights failed to put them over the top — including in Montana.

Texas Rep. Colin Allred, a Democrat, failed in his bid to defeat Sen. Ted Cruz after investing $5 million in an ad campaign focused on abortion and invoking the issue in campaign trail speeches and during an October debate. Allred leaned on the personal stories of Texas women impacted by the state's abortion ban that have sparked national outrage.

In Ohio, Republican Bernie Moreno defeated incumbent Sen. Sherrod Brown after Brown and his allies pounced on cellphone video that emerged late in the campaign showing Moreno criticizing suburban women who base their votes on abortion rights.

A hotly contested race between Democratic Sen. Tammy Baldwin and Republican Eric Hovde has also focused heavily on abortion and appeared to be close enough early Wednesday for a recount to be requested.

In the Texas city of Amarillo, located in the state’s conservative Panhandle region, voters overwhelming rejected an anti-abortion proposal that would have essentially banned travel for those seeking abortions out of state by allowing civil lawsuits against anyone who helps a local resident obtain an abortion.

The “Sanctuary Cities for the Unborn” ordinance was rejected by nearly 60% of voters.

“We hope to set the tone for not only the state, but the nation, that we will not penalize anyone for seeking health care when they’re facing an extreme travel ban in their own state," said Lindsay London, a nurse who helped found a group to oppose the effort.

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Associated Press reporters Sean Murphy in Oklahoma City and Jim Salter in O'Fallon, Missouri, contributed to this article.