Court again rewrites Missouri ballot question to repeal state 'right' to abortion

An appeals court has again rewritten Missouri ballot language that will allow voters to potentially overturn a broad state "right" to abortion.

Key Takeaways:

• In 2024, voters approved Amendment 3, which made abortion a constitutional right in Missouri.

• This year, Missouri lawmakers put forth a ballot initiative to overturn Amendment 3.

• The ACLU sued on behalf of Dr. Anna Fitz-James, and the ballot language has gone through a series of rewrites.

• In October, Circuit Judge Daniel Green ruled that language written by Secretary of State Denny Hoskins and approved by Attorney General Catherine Hanaway was "fair and sufficient."

• However, an appeals court has now rewritten the language again.

The Backstory:

One month after being approved by voters, Amendment 3 took effect, though laws regarding the safety of abortion in Missouri remained in place, such as a 72-hour waiting period, an informed consent requirement, and a requirement that the same abortionist who initially saw the patient for the consultation must be the one to commit the abortion.

Earlier this year, lawmakers introduced a ballot initiative to overturn Amendment 3, and the ACLU sued. Over the last several months, the ballot initiative has gone through a series of rewrites, as legal battles have repeatedly redefined what is considered accurate.

In September, Judge Daniel Green first ruled that while the initiative can appear on the 2026 ballot, the language needed to be changed. He said the initial language "fails to adequately alert voters that the proposed constitutional amendment would eliminate [the 2024 abortion rights amendment], which voters recently approved."

Missouri Secretary of State Denny Hoskins rewrote the language, with Green eventually approving it. That new ballot language would have read:

“Shall the Missouri Constitution be amended to:

• Guarantee women’s medical care for emergencies, ectopic pregnancies, and miscarriages; 

• Ensure women’s safety during abortions; 

• Ensure parental consent for minors; 

• Repeal Article I, section 36, approved in 2024; allow abortions for medical emergencies, fetal anomalies, rape, and incest;

• and Prohibit sex-change procedures for children?”

But the ACLU and Dr. Anna Fitz-James appealed, seeking significant changes to the bullet point that began with "Repeal Article I...."

The Details:

The Missouri Court of Appeals ruled in their favor. The ACLU and Fitz-James complained that the language still was not clear enough, and argued that voters could still believe the ballot was granting them abortion rights. The court agreed with her on most points, but disagreed on one.

Fitz-James argued that gender transition treatments are separate from abortion, and therefore, the ballot violates a statute requiring initiatives to focus on just one subject. The judges, however, disagreed.

“Because gender transition surgeries or hormone therapies may affect the ability to reproduce, gender transition surgeries and hormone therapies may be connected with, or incident to, reproductive health care,” they wrote.

The court still found that the ballot language was misleading, and it was rewritten again. The ballot will now read:

“Shall the Missouri Constitution be amended to:

• Repeal the 2024 voter-approved Amendment providing reproductive healthcare rights, including abortion through fetal viability;

• Allow abortions for rape and incest (under twelve-weeks’ gestation), emergencies, and fetal anomalies;

• Allow legislation regulating abortion;

• Ensure parental consent for minors’ abortions;

• Prohibit gender transition procedures for minors?”

The Bottom Line:

Hanaway expressed disappointment that the ballot was rewritten again, saying there was “there was no legitimate reason to displace it.” Yet she also said it was a "decisive victory" that the court ruled the initiative can remain on the 2026 ballot.