In 2024, Missourians approved a referendum guaranteeing a right to abortion up until viability. This time around, pro-lifers have a new strategy.
In 2024, President Donald Trump and fellow Republicans dominated Missouri, sweeping the reliably red state, but conservatives did face a difficult statewide loss in the Show Me State that cycle.
The state’s voters approved a permissive abortion referendum, known as the Right to Reproductive Freedom Initiative, by 3 percentage points, or about 95,000 votes, which struck down a state law that prohibited abortion except in cases of a medical emergency. The referendum guaranteed a right to abortion up until viability, about 24 weeks into the pregnancy, but opponents argued that the built-in exceptions to the 24-week limit meant the referendum effectively permitted abortion through all nine months.
This year, Missouri voters will once again be faced with an abortion-related ballot question, but pro-life groups may have found a more effective strategy this time around. Amendment 3 would repeal the right to abortion that voters approved in 2024, effectively banning most abortions except for the case of a medical emergency or fetal abnormality. Abortions in the case of rape or incest would be allowed up to 12 weeks. But that’s not all. If the measure is approved, it would also codify into the state constitution a ban on sex-change surgeries and hormone treatments for minors. Missouri passed a law in 2023 banning such procedures, but the prospect of enshrining it into the constitution could make voters who are a bit squeamish on abortion restrictions more comfortable voting “yes.”
“Missouri has a history of legislation and legal efforts in this area,” Sue Liebel, director of state affairs at Susan B. Anthony Pro-Life America, told National Review. “And so, we’re seeing that voters are, in fact, paying attention to the combined nature of the issues on the ballot initiative.”
Since the overturning of Roe v. Wade in the summer of 2022, the pro-life side has suffered several defeats in statewide ballot referenda, even in red states. Voters in Kansas and Kentucky rejected measures in 2022 that would have explicitly stated that their constitutions did not contain a right to abortion. The following year, Ohio voters approved a referendum that guaranteed a constitutional right to abortion, striking down the state’s six-week abortion restriction.
The pro-life movement did notch a couple wins in 2024, however. One came in Nebraska, where the ballot contained two abortion questions. One initiative would have recognized a constitutional right to abortion up to fetal viability, while the other would have banned abortions past the first trimester, giving the legislature room to restrict the procedure further. In the end, voters approved the moderate restrictions on abortion, while rejecting the permissive right to it. Juxtaposing a milder pro-life option with pro-abortion groups’ preferred policy proved successful in Nebraska. Missouri’s elections next month will test whether tying transgender issues to abortion will lead to a similar pro-life victory.
Stop the Ban — the effort to oppose Amendment 3, made up of groups that include the ACLU of Missouri and regional Planned Parenthood advocacy groups — is casting the ballot question as an effort to sneak an abortion restriction into a ban on child transgender treatments, which are already illegal.
“This amendment involving these two separate topics is a bait and switch trying to trick Missouri voters into banning abortion,” Stop the Ban spokesperson Tori Schafer told NR.
Pro-life groups insist that tying an abortion ban to the issue of child sex changes is not a strategic gambit, but necessitated by the language of the 2024 referendum.
“It was absolutely critical that that issue be included in this ballot language because they put it in their ’24 ballot language,” Missouri Right to Life executive director Susan Klein told NR. “They didn’t spell it out that way, but they don’t usually tell the truth right up front of what it is they’re after.”
Opponents of the 2024 measure argued at the time that because it guaranteed Missourians “the right to make and carry out decisions about all matters relating to reproductive health care,” the law could be interpreted to cover sex-change treatments for children as part of “reproductive health care.” The measure’s proponents rejected that claim.
Missouri’s law banning transgender treatments for minors has faced legal challenges, including from the state’s ACLU. Schafer of Stop the Ban, who is also contracted as an attorney for the ACLU of Missouri, noted that the group did not use the 2024 abortion amendment to support its lawsuit, but she also did not rule out using it for that purpose.
“The Right to Reproductive Freedom was in effect when that lawsuit was going on, and the Right to Reproductive Freedom was not used in that way,” she said.
Legal challenges notwithstanding, restrictions on transgender treatments for children are popular in both Missouri and the country more broadly. A New York Times poll from January 2025 found that 71 percent of Americans believe that minors should not have access to hormone therapies or puberty blockers. A St. Louis University poll of Missourians from February of this year found that at least 67 percent of the state’s voters oppose children receiving both hormone therapy and surgeries.
But abortion restrictions, depending on where they land in the pregnancy, are not as popular as those on child sex changes. In the same survey, 59 percent believed abortion should be legal in the first eight weeks of the pregnancy, but just 47 percent believed that at twelve weeks, and only 35 percent supported legal abortion at 15 weeks.
Despite their reticence to support the amendment’s abortion measures, Missourians were breaking in its favor. The February SLU poll found that 47 percent of Missouri voters supported Amendment 3, compared to 40 percent who opposed it. But that support has since slipped. An August SLU poll found that just 43 percent supported it, while 44 percent opposed it.
In the final stretch before Election Day, the pro-life side has two major disadvantages. The first is an enthusiasm gap. With this year’s midterms occurring during a Republican trifecta, Democratic voters across the country, who skew more pro-choice, are much more energized to turn out to vote than Republican, pro-life ones. Add to that the fact that there are no races for major statewide offices like governor or senator in Missouri this year. Nevertheless, Missouri Right to Life’s Klein argued that pro-life voters would go to their polling places next month.
“Missouri is a pro-life state, and they know they were sold a bill of goods by the abortion industry,” she said. “So even though this is a midterm, pro-lifers turn out to vote.”
The second disadvantage is a massive fundraising gap. Since the beginning of the election cycle, Stop the Ban has raised about $20 million, compared to the $3 million brought in by Her Health, Her Future, the main PAC supporting the amendment. The pro-life side has attacked its opponents for their out-of-state contributions. Their total includes, as of last month, more than $5 million from the Fairness Project, a Washington, D.C.-based progressive policy nonprofit. Schafer pushed back against such attacks.
“Missourians led this fight,” she said. “Missourians are the reason it was on their ballot in 2024, and it’s politicians who are trying to undo the voters’ vote.”