Amendment 3: Right to Reproductive Freedom Initiative
Thursday, September 26, 2024
A critical health-focused ballot measure on the November 5 election ballot is Amendment 3, or the “Right to Reproductive Freedom Initiative.” The amendment would establish the constitutional right to an abortion. Since the overturning of Roe v. Wade in June 2022, nearly all abortions became illegal in Missouri, with few exceptions for the health of the pregnant person.
To achieve our vision of zero health disparities, the Community Health Commission of Missouri prioritizes achieving health equity. The passing of Amendment 3 would support and improve maternal health outcomes by removing barriers to access to necessary health care and reinforcing the belief that everyone in our state should have the opportunity to determine if, when, and under what circumstances to get pregnant.
In addition to abortion, the amendment would also solidify other reproductive rights into the constitution, such as postpartum care, miscarriage care, respectful birthing conditions, and birth control. Birth control is still legal in Missouri, but the amendment would enshrine the right to access forms of contraception into the Missouri Constitution.
If the Amendment passes, the General Assembly will have the opportunity to regulate abortion after the point of fetal viability. When a pregnancy reaches fetal viability, it means the fetus could survive outside of the womb. However, the government will not be allowed to delay or restrict an abortion past that point if the pregnant person’s life is at stake and a health care provider deems an abortion necessary. The proposed amendment eliminates penalties for pregnancy outcomes, including miscarriage, stillbirth, and abortion. The government will also not be allowed to “discriminate against persons providing or obtaining reproductive health care or assisting another person in doing so.”
Frequently Asked Questions
Will the Amendment allow abortion until birth?
No, not without government regulation and only to protect the health of the birthing person. Amendment 3 allows for government regulations after the point of fetal viability, which is typically around 24 weeks.
When rare third-trimester (weeks 28-40) abortions do happen, these decisions are made in the context of serious and often life-threatening medical conditions or severe fetal abnormalities. Data from the Centers for Disease Control and Prevention show less than 1% of abortions were performed at or after 21 weeks
Seeking an abortion after the point of viability is not a decision made in isolation or on a whim—they involve licensed healthcare professionals, who follow strict medical guidelines to ensure that any care provided is in line with the patient’s needs and with the goal of minimizing suffering.
Does the Amendment include gender-affirming care?
No. Amendment 3 has nothing to do with gender-affirming health care for minors or adults and does not include language about gender-affirming care. Amendment 3 would not change the way Missouri regulates this care or the insurance that covers it.
While some may speculate about gender-affirming care being included under reproductive freedom in the future, it is not the focus or intent of this particular amendment, nor is that likely to be considered by the courts of Missouri. If broader definitions were considered down the road, all care in Missouri would still need to adhere to widely accepted clinical standards and evidence-based medicine. This means that any care provided—whether it’s care protected in this amendment or otherwise—will continue to be subject to rigorous medical oversight to ensure it’s safe and appropriate.
Are healthcare providers still held accountable when providing reproductive care?
Yes! Missouri’s Western District Court of Appeals already ruled in October 2023 that abortion providers would remain liable for malpractice if abortion rights were restored in the state.
In reality, Amendment 3 seeks to protect the right to abortion and ensuring it’s treated as a legitimate medical procedure, governed by the same rigorous clinical and evidence-based standards that apply to other healthcare services. Rather than making abortion lawless or unregulated, Amendment 3 restores abortion as a protected medical service and empowers providers to make decisions based on science and the health of their patients, rather than politics. Ultimately, this helps ensure that anyone seeking an abortion in Missouri receives safe, medically sound care.
If the Amendment does not pass, does Missouri allow for abortions in the case of rape or incest?
Current Missouri law does not provide exceptions for rape or incest. The only exceptions are for medical emergencies that endanger the life of the pregnant individual or pose a serious risk of significant and irreversible damage to a major bodily function. If amendment 3 is rejected, current Missouri law will remain in place, which outlaws non-medically necessary abortions.
How is abortion an equity issue?
Access to abortion in Missouri—and in many states—raises significant equity concerns due to how restrictions disproportionately affect people based on socioeconomic status, race, geographic location, and other factors.
Socioeconomic Status
Abortion access restrictions often place a heavier burden on lower-income individuals. Missouri, for example, has implemented waiting periods and mandatory counseling, which means people may need to take multiple days off work and incur travel and lodging costs to access services, as clinics are often scarce or far from rural areas. Lower-income individuals have fewer resources to cover these additional costs and often cannot afford to travel out of state if necessary.
Racial Disparities
Racial inequities in healthcare access compound the issue. Black and Hispanic communities face higher poverty rates in Missouri, increasing their reliance on accessible reproductive healthcare. Limited abortion access disproportionately impacts women of color, who often experience systemic barriers in healthcare, leading to poorer health outcomes, higher maternal mortality rates, and reduced access to family planning resources.
Geographic Inequality
Missouri has very few abortion providers, and most are located in urban areas, making access difficult for people in rural regions. Residents in rural Missouri, where there are few reproductive healthcare services, must travel long distances to find a provider, facing additional transportation costs and the potential stigma of traveling openly for an abortion.
Gender Equity
Restricting abortion access reinforces inequities in gender autonomy. Reproductive choices significantly affect educational and career opportunities, financial stability, and personal agency, disproportionately impacting birthing people who may become pregnant. Limited abortion access restricts these opportunities, entrenching gender disparities.
For more information about frequently asked questions and clarification around misinformation, check out this article by the Kansas City Star.
Ballot Summary Lawsuit
The Secretary of State created a summary of the amendment designed to mislead voters. As a result, abortion-rights activists challenged this summary, claiming that voters were being misled.
A Missouri judge agreed with the activists and ruled that the summary was unfair and created unnecessary confusion about the amendment. The initial summary led voters to believe the amendment would allow medical professionals to perform abortions negligently or criminally.
In reality, the proposed amendment aims to eliminate criminal penalties for providers who perform abortions and for patients who are seeking them. Physicians in Missouri currently face penalties of up to 15 years in prison if they perform an abortion.
Maternal Health Cost in Missouri
Many birthing people struggle to afford abortions, especially those without health insurance. The Hyde amendment was introduced at the federal level in order to restrict funding for abortion access. The Hyde Amendment requires that federal funds cannot be used to cover abortions unless the pregnancy is a result of rape or incest, or if the pregnancy endangers the mother’s life. This means that abortions in Missouri are only funded by Medicaid if their abortion meets those specific requirements. However, the majority of people who tend to seek abortions are covered under Medicaid, and this lack of funding due to the Hyde Amendment often leads to devastating consequences, both physically and financially.
Restricting reproductive health care, such as abortions, has far-reaching consequences. If abortion was completely banned in the United States, the overall number of maternal deaths would rise by 24%. Maternal deaths among Black birthing people would rise by 39%. The US currently has one of the highest maternal mortality rates among industrialized countries.
Missouri already presents a high risk for unfavorable reproductive health outcomes. These outcomes are primarily due to inadequate access to quality reproductive health services, which is driven by socioeconomic determinants, limited access to primary healthcare, lack of mental health support, and substance use. The abortion-restriction in Missouri only exacerbates the maternal, perinatal, and neonatal mortality rates. 39% of the counties in Missouri are maternity care deserts, meaning birthing people must travel farther to see providers.
Abortion-Access Data
The point of Fetal Viability is considered to be around the 24th week of pregnancy. In 2022, the majority of abortions were performed prior to the 24 week mark (just over 99%). The bulk of abortions are typically performed before the 9 week mark (59%). This data is based on recorded abortions in 2022, and does not take into account the trigger ban that went into effect after Roe was overturned. The Guttmacher Institute has recorded that in 2023 over 10,000 Missouri women sought reproductive care in Kansas and Illinois. Self-managed medication abortions have increased by 26,000 across the country.
The Bottom Line
When abortions and reproductive health care are restricted, people die of preventable causes. Thousands of women across Missouri have been facing struggles since the abortion ban. Many struggle to find a provider to care for their basic needs. Others are struggling with unplanned pregnancies. Abortion bans do not help women and birthing people, but a “yes” on Amendment 3 helps all Missourians achieve health equity.
We know that access to reproductive healthcare is critical for health equity. Restricting abortion disproportionately affects marginalized groups, including low-income women, women of color, and those with limited access to healthcare, exacerbating existing health disparities. By safeguarding abortion rights, the measure would ensure that all women, regardless of socioeconomic status, have the ability to make informed decisions about their health, reducing barriers to comprehensive care and promoting overall reproductive justice.