Just two years after Missouri voters approved an amendment enshrining the right to reproductive freedom in the state constitution, abortion, which was also protected by the measure, is on the ballot there again.

On Nov. 3, Missouri residents will be voting on Amendment 3, only this time it would prohibit abortion, except in cases of medical emergencies, fetal anomalies, rape or incest. If the abortion is due to rape or incest, the procedure must occur no later than 12 weeks' gestation.

Since Roe v. Wade was overruled by the Supreme Court in June 2022, 13 states have ceased nearly all abortion services while four states have a six-week ban on books, according to an ABC News tally.

Following the Supreme Court decision, Missouri enacted a trigger ban, prohibiting most abortions in the state.

However, in November 2024, Missouri became the first state to overturn a near-total abortion ban through a direct vote of the people by passing Amendment 3 -- the same name as the upcoming ballot measure -- with about 52% of the vote.

"Missourians have access to abortion care because the people made it possible," Mallory Schwarz, executive director of the nonprofit Abortion Action Missouri, told ABC News. "But not even months after our 2024 vote, politicians started plotting to overturn the will of the people and now, in a couple of weeks, voters will have to vote again to protect the right to abortion that we enshrined in the constitution previously."

What is Amendment 3?

Amendment 3 would repeal the 2024 amendment that granted reproductive freedom, including abortion through fetal viability, which is typically between 24 and 26 weeks' gestation.

If approved, the amendment would also permit state lawmakers to enact legislation to regulate abortions and access to care.

Examples include laws requiring physicians providing abortion care to have admitting privileges at a nearby hospital and licensing requirements for abortion facilities.

State Sen. Adam Schnelting, who sponsored the proposal that led to Amendment 3 being placed on this year's ballot, told ABC News that passing the amendment is "critical to protecting women and children and providing Missourians with a measure that is more in line with their values than the one narrowly passed two years ago."

The amendment would also prohibit gender-affirming care procedures, cross-sex hormones or puberty-blocking drugs for minors. However, gender-affirming surgeries and medical treatments for minors are already illegal in Missouri under statutory law.

Opponents of the amendment have argued that including language about gender-affirming care is an attempt to mask the parts of the amendment that would limit abortion care.

"What politicians are trying to do is mislead voters and overturn the will of the people and ban abortion again," Tori Schafer, director of the ACLU of Missouri, told ABC News. "And they've shown they're willing to resort to all kinds of tricky tactics in order to do that."

Schafer said organizations supporting Amendment 3 don't use the word "abortion" in their ads campaigning for the amendment to pass "because they know, like we know, that abortion care is popular in Missouri."

Schnelting said the statutory ban on gender-affirming procedures and treatment for minors expires in 2027 and including that language in Amendment 3 would ensure such a ban is permanent.

Possible consequences if Amendment 3 is passed

After the trigger ban was passed in Missouri in 2022, the state's last abortion clinic in St. Louis was forced to stop providing such care.

In 2023 alone, more than 12,000 Missouri women traveled to neighboring states, including Illinois and Kansas, to receive care, according to the Guttmacher Institute, a reproductive rights organization.

Additionally, in 2025, more than 3,000 Missourians obtained medication abortions through telehealth from out-of-state clinicians, nearly four times higher than two years prior, the Guttmacher Institute found.

Some abortion providers told local news outlets they were seeing patients develop complications while waiting for treatment and some patients said they'd had to flee Missouri to seek abortion care for conditions including fetal anomalies.

"Missourians have lived under an abortion ban in the past," Schwarz said. "We've seen people turned away from the emergency room when they needed emergency abortion care. We've seen women forced to wait until their complication was serious enough that they were able to access care or have to flee the state to get care in another state that they should be able to get in their own community."

Schwarz said Abortion Action Missouri's canvassers have had conversations with Missourians against Amendment 3 from all walks of life.

One such conversation was with a Catholic voter who said they did not support abortion rights but also did not support the new amendment.

"They said, 'I'm personally pro-life, but we already voted on this and I'm voting
"no" this time because politicians should be listening to the people,'" Schwarz said. "'Politicians shouldn't get to overturn any vote just because they don't like it.' And so, we are hearing that [at] the doors every day, every weekend."

Schnelting said the response to Amendment 3 from his constituents has been largely positive and called the claims that it is overturning the will of the people a "specious argument."

Anti-abortion rights groups have praised the new Amendment 3, arguing that the 2024 vote was extreme and goes beyond what Missourians have historically supported.

"Despite what voters were sold before Election Day, as soon as [2024's] Amendment 3 passed, the abortion lobby brought litigation to perform late-term abortions, end parental consent and remove every safety regulation on their industry," Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement last year. "Amendment 3 is far too extreme and dangerous."

Missouri is not the only state with abortion on the ballot on Nov. 3. Voters in three states -- Idaho, Nevada and Virginia -- will consider measures to protect abortion rights and, in some cases, reproductive freedom.

Schafer, from ACLU of Missouri, said other states can learn from Missouri about how access to abortion can be at risk even after voters vote to protect care.

"While this fight is really important to folks like me who live in Missouri and have to suffer the consequences of our legislature ignoring the will of the people, we know that this campaign will also impact folks all across the country," Schafer said. "We have friends in other states who have passed their own versions of the right to reproductive freedom, and we don't want this attempt by our legislature to embolden this opposition strategy across the country."

She went on, "So we know that a lot of eyes are on Missouri, and Missourians deeply believe in the right to make their own decisions free from political interference."

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