Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday, including in Missouri, among the first states to ban abortion after the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization. At first glance, the nation’s patchwork of abortion rules was seemingly reshaped.
But when Alison Dreith, director of strategic partnerships at the Midwest Access Coalition abortion fund, which has helped people from Missouri and 27 other states get abortions, was asked before the results came in how her organization was preparing for logistic changes, she simply said: “We’re not.”
That’s because actual access to abortion in the country remains largely unchanged despite Tuesday’s results. The web of preexisting state laws on abortions could remain in place while they are contested in court, a process that could take months or longer.
States that passed abortion rights amendments in 2022 and 2023 offer a view into the lengthy legal road ahead for abortion policies to take effect. It took nine months after Ohio voters added abortion protections to their state’s constitution for a judge to strike down the state’s 24-hour waiting period for abortions. And some of Michigan’s abortion restrictions, including its 24-hour waiting period, were suspended only in June, 19 months after Michigan voters approved their state’s abortion rights amendment.
Missouri has an extensive set of such rules. Legal abortions had almost ceased even before the state’s ban was triggered by the Dobbs decision. Over three decades, state lawmakers passed restrictions on abortion providers that made it increasingly difficult to operate there. By 2018, only one clinic was providing abortions in the state, a Planned Parenthood affiliate in St. Louis. Anticipating further tightened restrictions, it opened a large facility 20 miles away in Illinois in 2019.
The laws that reduced the number of recorded abortions in the state from 5,772 in 2011 to 150 in 2021 remain on the books, despite the newly passed amendment protecting abortion rights. The state’s two Planned Parenthood affiliates filed a lawsuit Wednesday challenging those laws and requesting a preliminary injunction blocking their enforcement so the groups may resume abortion services in the state when the amendment goes into effect Dec. 5.
The state’s Republican-dominated legislature has attempted to ignore previous voter-passed amendments. After Missouri voters added Medicaid expansion to the state’s constitution in 2020, the state legislature refused to fund the program until a judge ordered the state to start accepting applications, prompting significant delays in enrollment. The state’s presumptive House speaker, Republican Jon Patterson, has said the legislature must respect the outcome of the Nov. 5 ballot measure vote, while others have pledged to bring the issue to voters again.
Abortion services often get talked about like a light switch, according to Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, a nonprofit that supports abortion rights. But the infrastructure needed to provide abortions is not so easy to turn on and off.
North Dakota’s abortion ban was repealed by the courts in September, for example, but the lone provider of abortions in the state before the ban took effect has no plans to return, having moved operations a five-minute drive away to Minnesota.
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