After months of court battles and internal squabbles, a coalition of Missouri abortion-rights organizations plan to officially launch an effort Thursday to put a constitutional amendment on the 2024 ballot to legalize abortion up until the point of fetal viability. 

Despite reports of discord within the coalition, the campaign has the support of Abortion Action Missouri, the ACLU of Missouri and Planned Parenthood affiliates in Kansas City and St. Louis.

Missouri has one of the most restrictive laws in the country, banning all abortions except in the case of medical emergencies. A political action committee called Missourians for Constitutional Freedom announced Thursday it would begin to gather signatures to put an initiative petition on the statewide ballot rolling back that ban. 

Missouri abortion-rights amendments face ‘torturous’ process to make it to 2024 ballot

The organization has settled on a version of its 11 initiative petitions that would allow the legislature to “regulate the provision of abortion after fetal viability provided that under no circumstance shall the government deny, interfere with, delay or otherwise restrict an abortion that in the good faith judgment of a treating health care professional is needed to protect the life or physical or mental health of the pregnant person.”

The proposed constitutional amendment won out over other versions, including one that would have sought to make abortion legal up to 24 weeks of pregnancy and another that would have removed any gestational limits on abortion completely.

“Missouri’s cruel and restrictive ban on abortion is tying the hands of doctors and preventing necessary care,” Dr. Iman Alsaden, advisor to Missourians for Constitutional Freedom and chief medical officer for Planned Parenthood Great Plains, said in a statement. “Missourians are taking a critical step to make their own medical decisions and kick politicians out of the exam room.” 

The coalition has until May 5 to gather more than 171,000 valid signatures from across the state. If they succeed in this expensive endeavor, the amendment will appear on the statewide ballot. 

A competing Republican-led ballot initiative, which started collecting signatures in November, is seeking to enshrine abortion rights in the constitution up to 12 weeks. It would also allow exceptions for rape and incest.

Dr. Selina Sandoval, who works as a full-time abortion provider in Kansas, said that practically every day she sees patients traveling from Missouri to Kansas for care. She said after the “devastating” news that the U.S. Supreme Court overturned Roe v. Wade, she’s hopeful change may be on the horizon.

“We’re very optimistic. We know that the majority of Americans and the majority of Missourians feel that abortion should be legal and accessible,” said Sandoval, who is also associate medical director at Planned Parenthood Great Plains. “They are risking financial security, they’re having to travel across state lines. And it’s just a very unnecessary, cruel, very unjust ban that we’re facing.”

Viability language

In the nearly 19 months since the June 2022 Dobbs v. Jackson Women’s Health Organization decision put abortion laws in state’s hands, voters in seven states have approved ballot measures to preserve or expand abortion access. 

Abortion-rights advocates have said they are confident an attempt to expand access would also pass in Missouri. But they were less sure of just how far to go in a state that has veered from a swing state to staunchly Republican over the last two decades.

Proponents settled on viability language, defined in the initiative petition as the point in pregnancy when “there is a significant likelihood of the fetus’s sustained survival outside the uterus without the application of extraordinary medical measures.” 

Viability language is also drafted into proposed ballot measures this year in Arizona, Florida, Nebraska and Nevada. Last fall, Ohioans voted to legalize abortion up to the point of viability. 

Viability can be difficult to define, though it’s usually determined to be between 20 and 25 weeks gestation. Despite the language being somewhat common in state laws, it’s also controversial. The American College of Obstetricians and Gynecologists has dissuaded the use of viability limits in legislation, as there is no single clinical definition of viability.

“Legislative bans on abortion care often overlook unique patient needs, medical evidence, individual facts in a given case, and the inherent uncertainty of outcomes in favor of defining viability solely by gestational ages,” the college wrote in a statement online. “Therefore, ACOG strongly opposes policy makers defining viability or using viability as a basis to limit access to evidence-based care.”

Mallory Schwarz, executive director of Abortion Action Missouri, said the coalition believes the viability language meets most Missourians where they are. 

“Many members of our coalition are out talking about abortion with Missourians every day, and we know that Missourians often have complex or nuanced positions on abortion, but there is one thing that they are aligned in, and it’s that they want to end the abortion ban,” Schwarz said. “That they do not support the abortion ban we are living under today, and we are confident this is our best path forward.”

Race to gather signatures

Abortion-rights groups around the state have blamed Secretary of State Jay Ashcroft for the delay in getting a petition off the ground. 

In November, Missourians for Constitutional Freedom, backed by the Missouri ACLU, won a legal battle over the ballot summary language, giving the coalition the green light to move ahead with signature gathering.

“Any campaign that would move forward is left to contend with a myriad of challenges, including a severely constricted timeline,” Schwarz said following a November court ruling. “At the same time there is incredible opportunity and there’s hope here because we continue to see abortion rights and access remain a top priority for voters across the country.”

Now Schwarz said she is confident they can raise the money to get the signatures they need despite the short timeline, though she didn’t provide clarity on how much money has been raised, or how soon signature gathering will begin.

In Ohio, more than $70 million was spent on both sides in the fight over enshrining abortion rights in the state constitution, the Associated Press reported. This included several million in donations toward the pro-abortion movement from national funders.

The question remains for both of Missouri’s coalitions: Is there enough time and financial support to successfully gather the necessary signatures by May?

As of their January quarterly fundraising report filed to the Missouri Ethics Commission on Tuesday, the group had no cash on hand. They raised just shy of $13,500 in 2023, mostly in in-kind donations from the ACLU of Missouri for legal representation.

In mid-November, Jamie Corley, a longtime GOP Congressional staffer, launched a campaign effort for an initiative petition that would add rape and incest exceptions to Missouri’s abortion ban and legalize the procedure up to 12 weeks. 

Like Missourians for Constitutional Freedom, Corley’s initiative also seeks to protect doctors and pregnant patients from prosecution. Currently, any health care providers who violate the law can have their medical licenses suspended or revoked and face a class B felony, and five to 15 years in prison. 

As of Tuesday, Corley had raised more than $61,000, and had spent little of it, according to the Missouri Ethics Commission. The majority of the donations were given by Corley herself.

Experts have called Missouri’s signature gathering process costly and “tortuous.” 

Jack Cardetti, who helped run a number of successful initiative petition campaigns in Missouri, previously told The Independent that high dollar donations can be an indicator of success as the deadline to collect signatures from six of Missouri’s eight congressional districts draws near. 

Anti abortion group mobilizes against ballot efforts

Last week, a political action committee called Missouri Stands with Women was launched to “push back against the Big Abortion Industry.”

The committee, whose president is veteran anti-abortion activist Sam Lee, was formed to fight any abortion initiative petitions that make it to the ballot.

“Out-of-state extremists pushing Big Abortion’s agenda are intent on using the initiative petition process to reverse all the pro-life work our state has undertaken to protect the dignity of life, safety of women and parental rights,” Stephanie Bell, a spokeswoman for Missouri Stands with Women and a lawyer based out of Jefferson City, said in a news release Tuesday. 

As of Thursday morning, the group had received one donation of just over $5,000, from the Missouri Catholic Conference.

In the December issue of The Messenger, a publication by the Missouri Catholic Conference, a letter from Missouri bishops encouraged Missourians to vote against any abortion initiatives that make it to the ballot.

“Even with legal protections for the unborn, as we have in our state today, more can still be done to build a culture of life,” the bishops wrote.

Missouri has long been a national example of what a state might look like post-Roe. 

Since 2018, Missouri was already down to just one abortion clinic. Prior to the trigger law, abortion was banned after eight weeks in Missouri.

Missouri anti-abortion lawmakers for years have been making abortion access more difficult. 

Before abortion became illegal, Missouri law required doctors to have admitting privileges at close hospitals before performing abortions. Patients sought abortions first had to receive state-mandated counseling from the doctor which discouraged abortion. If the woman still wanted to proceed, she then had to wait 72 hours to get the procedure, which had to be done by the same doctor who issued the counseling.

As a result, the number of abortions performed in Missouri dropped dramatically. In 2021, only 150 abortions were performed in Missouri, according to state health department data.  

But many thousands of Missouri women are still getting abortions. In 2020, more than 3,200 Missourians received abortions in Kansas, according to the state health department. The same year, more than 6,500 Missourians received abortions in Illinois.

Thursday’s news release from the coalition also highlighted Missouri’s alarming rates of maternal mortality and morbidity, in part due to pregnancy complications.

“OBGYNs and maternity practices are packing up and moving away to avoid political harassment and criminalization,” the release read. “We don’t have time to wait. Together, we are going to end Missouri’s cruel abortion ban.”