This story was updated at 1 p.m. on Nov. 8.

Missouri voters bucked Republicans who control the state on Tuesday when they voted to add the right to abortion and other reproductive health care protections in the state constitution by passing Amendment 3. 

The measure was approved 51.6% to 48.4%, making Missouri the first state to reverse a statewide near-total ban on abortion. 

The ban was the first of its kind after the fall of Roe v. Wade in 2022 put the issue under state control. In Missouri voters’ first chance, they sided against lawmakers to defend abortion rights.

Less than 24 hours after the measure passed, Planned Parenthood filed a lawsuit seeking to block some of Missouri’s restrictive abortion laws. The group hopes to be providing abortion care by Dec. 5.

Legal battles in other states give clues as to how restoring abortion rights may unfold in Missouri. Anti-abortion activists and politicians will likely work to protect waiting periods, mandatory counseling and other laws designed to limit abortion access. 

And even before Missourians started voting, anti-abortion lawmakers vowed to ask voters to undo the amendment they just added to the Missouri Constitution.

In the meantime, the specific restrictions that might remain around abortion fall to Missouri judges. 

Prior to Tuesday’s election, neighboring Kansas and six other states voted on abortion ballot questions. They provide context about how courts, state officials and activist groups will handle the changing landscape of abortion access in Missouri in the months and years ahead. 

Ohio lawmakers vowed to keep abortion laws on the books 

Ohio voters passed a ballot measure in November 2023 that enshrined abortion access in the state’s constitution, after lawmakers sought to prevent the measure from passing. 

The state’s political climate closely mirrors Missouri’s, with Republicans in control of the legislature and every major statewide office. 

Days after Ohioans approved the ballot measure, members of the Ohio House signed onto a letter vowing to do everything in their power to prevent the state’s abortion laws from being stripped away under the amendment. 

Some conservative lawmakers also floated legislation that would undo parts of the new amendment by taking away the court’s authority to rule on cases related to implementing or enforcing the amendment.

“When a new constitutional amendment passes and there are state laws that conflict with it, nothing happens automatically,” said Jessie Hill, a cooperating attorney with the ACLU of Ohio, of challenges to Ohio’s abortion laws. 

So far, courts have generally ruled with the arguments that the ACLU and other abortion-rights groups make. But those decisions are being appealed and will likely make their way to the Ohio Supreme Court. 

“Not unlike Missouri, tons and tons of abortion restrictions passed over the years,” Hill said. “We’re … trying to get the courts to agree that now that we have this amendment, those laws can’t be enforced anymore.”

But in May, Ohio Attorney General Dave Yost argued in a court filing the governor is duty-bound to defend state laws that the abortion amendment did not directly invalidate. Yost also argued that abortion clinics lacked the authority to challenge laws like waiting periods. 

So far, abortion rights forces have been winning in the Ohio courts. But legal challenges present possibilities for anti-abortion groups and politicians looking to impede restoring abortion access in Missouri. 

Missouri Attorney General Andrew Bailey, who was elected to another term on Tuesday after legal efforts that made it harder to get Amendment 3 on the ballot, will be responsible for interpreting the amendment’s language and court decisions to state agencies. 

“I’m sure (Bailey) will be aggressive in providing interpretations that are the most conservative and most limiting on abortion rights,” said Peverill Squire, a political science professor at the University of Missouri-Columbia. 

One year after voters chose to enshrine the right to abortion access, Ohio’s six-week abortion ban has been permanently blocked by courts. Waiting periods and counseling are still required in Ohio, but those provisions also are being challenged in the courts. 

In blue Michigan, conflicting abortion laws were quickly stripped by the legislature 

In November 2022, Michigan voters approved language enshrining abortion and reproductive health care into the state’s constitution. The Michigan language closely mirrors what Missourians approved at the polls this week, but the state’s political outlook could not be more different. 

Michigan’s government is largely run by Democrats at the state level, including a Democratic legislature. After Michigan voters passed its abortion rights amendment, the legislature began unwinding parts of state law that conflicted with it. 

Lawmakers worked on walking back the restrictions for over a year, but could not undo everything abortion-rights supporters thought was possible under the new constitution. It took 15 months after the measure passed before abortion-rights groups started filing lawsuits to eliminate some of those restrictions. 

In June, a Michigan Court of Claims judge granted a temporary block to restrictions such as the state’s 24-hour waiting period, informed consent and the state’s previous ban on advanced practice clinicians, like nurse practitioners, providing abortions. 

“The 24-hour waiting period forces needless delay on patients after they are able to consent to a procedure, thus burdening and infringing upon a patient’s access to abortion care,” Judge Sima Patel wrote in her ruling. 

University of Missouri-Kansas City law professor Yvette Lindgren expects similar challenges to the Missouri laws that placed restrictions on abortion providers. 

“All of these interlocking laws that essentially made abortion effectively unavailable in Missouri, even before the Dobbs decision, there will be strong arguments made that those laws are still in effect,” Lindgren said. 

Kansas lawmakers looked for places to limit abortion 

In red Kansas, voters approved an amendment enshrining the right to abortion in the state’s constitution in August 2022. Since then, Republican officials and the Republican-led legislature have looked for ways to place restrictions on abortion. 

During the 2024 legislative session, at least 110 legislators voted against abortion-rights legislation. Sixty-six of those lawmakers came from districts that voted against the ban, the Kansas Reflector reported. 

Lawmakers overrode Democratic Gov. Laura Kelly’s veto of a bill that requires medical facilities and providers to report the reasons that women are seeking abortions. The law requires patients to answer a series of questions before undergoing the procedure. 

Lawmakers also overrode Kelly’s veto on a bill that created a new felony for people who try to force a woman to end a pregnancy despite an expressed desire to give birth. The penalty could mean years of jail time and thousands of dollars in fines. 

What’s next for abortion in Missouri after Amendment 3 passed? 

Planned Parenthood filed its lawsuit to temporarily block some of Missouri’s abortion restrictions the day after the measure passed. 

For anti-abortion groups looking to prevent those changes from happening, arguments have been brought forward in Michigan to sue on federal constitutional grounds. Judges could hear arguments about Amendment 3 violating the First Amendment or parts of the U.S. Constitution granting equal protection. 

“There will be a lot of legal messiness surrounding this. It will initially probably fall to judges in Cole County to begin to sort it out,” Squire said. “There are gray areas and questions about the extent to which laws that are already on the books will be maintained or overturned, and so it will take some time to sort out all of that.” 

Many of the cases will land in the dockets of judges in Cole County, home to the state Capitol. Squire said those generally conservative judges don’t always rule the way that Republican politicians would like. 

It’s something that anti-abortion groups are preparing for, said Byron Keelin, the president of the conservative grassroots group Freedom Principle Missouri. 

“We’ve been talking with several attorneys and even lawmakers about possibilities,” Keelin said. “The problem is, the way that this amendment is written pretty much prohibits the legislature from doing anything on the fringes.” 

Keelin said lawmakers will likely wait for courts to rule on initial cases before lawmakers begin crafting a plan for an amendment to undo the changes set forth in Amendment 3.

“So it may not actually be until the 2026 legislative session,” he said, “before they can actually even determine what language they would need to repeal.” 

Gov.-elect Mike Kehoe said on Thursday that abortion access will remain a flash point in Missouri. 

“I’m sure there’ll be a lot of conversation about what can be done both from a legal standpoint or can’t be done from a legal standpoint, and what options the legislature will have before them,” Kehoe said. “And I’m sure you’ll hear more about it as it moves forward.”

Kehoe expressed interest in reverting to the state of abortion access before the Amendment 3 vote, but adding on rape and incest exceptions, which are not currently a part of Missouri law. 

“There’s probably an eagerness among some of the anti-abortion members to just try to throw it back up on the ballot in 2026,” Squire said. “But I think most people are probably kind of weary of it, waiting to see how it actually plays out now that some of the limits have been removed.”