With primary races decided and reproductive health care a top concern for many voters heading into the November general elections, stakeholders are assessing the year ahead and what possible legislation related to reproductive rights could be introduced in Missouri. 

The U.S. Supreme Court ruling in June that effectively removed constitutional protections to abortion access allowed Missouri to enact its trigger law, passed in 2019 as part of HB 126. 

Missouri was the first state to sign its trigger ban into law. The Right to Life of the Unborn Child Act makes all abortions in the state illegal with the exception of when the mother’s life is in danger. 

Democratic lawmakers have fears about what could be next when it comes to reproductive health care in Missouri. At the same time, anti-abortion groups are encouraged by results of the state’s Aug. 2 primary, which firmed up nominees in uncompetitive general election races. They say those wins will bolster conservative power in the Senate and help advance their policies. 

In the meantime, Planned Parenthood Great Plains in Kansas City says its clinics in the region are booked out for weeks. 

“People were shocked when they needed care and it was going to be sometimes up to two weeks,” Emily Wales, president of Planned Parenthood Great Plains, said. “And now that would be really lucky. Any patients who they could get in within a couple of weeks would be lucky. There is just such high demand. And people are panicked.” 

‘Initial fear’ passed, but demand for care has not gone away

Wales said the weeks after Missouri’s trigger law went into effect were chaotic as providers looked to a state statute that left some questions unanswered. Democratic leaders in the Missouri General Assembly called for a special session to clarify the language, after some hospitals temporarily stopped providing emergency contraception due to the “ambiguous” language. 

Even though some of the law has been clarified, House Minority Leader Crystal Quade, D-Springfield, said her constituents are still struggling to get care for medical conditions outside of pregnancy. She pointed to a person in her district who has struggled with long-term illness and has had to pause medication and treatment because her providers are unsure of how to navigate the law. 

Wales said the uncertainty that came with the early days of the trigger ban has passed, but the demand for other forms of reproductive health care is growing. 

“That initial fear of ‘I’m doing something illegal or I’m seeking illegal care by asking for birth control’ — that has gone away, but the demand for long-acting contraception has not gone away,” Wales said, adding that Great Plains offices are booked with patients looking to get long-acting birth control, like intrauterine devices or prescriptions for birth control pills.

Bills to block access to things like emergency contraception have been introduced in Missouri in the past, which Wales said makes it easy to believe they’ll pop up again. 

“We heard from some elected officials in the legislature saying that anything could be on the table, and we think they’re honest about that,” she said. 

A majority of Missourians support access to an abortion before eight weeks, according to a new poll conducted by St. Louis University and YouGov. 

Of the 900 Missourians surveyed, 58% supported a woman’s right to an abortion after eight weeks of pregnancy, versus 32% who disagreed. Although the only exceptions in Missouri’s trigger laws are to protect the life of the mother, 75% agreed that someone should be able to get an abortion in cases of rape and 79% supported the ability to get an abortion in cases of incest. 

What could come next for reproductive rights in Missouri?

While it is uncertain what the makeup of the next Missouri General Assembly will look like, stakeholders are preparing for a range of scenarios when it comes to legislation surrounding reproductive rights.

Wales and Quade pointed to Missouri’s 2021 special session, where then-Sen. Paul Wieland introduced a measure to prevent state Medicaid funds from funding contraceptive treatments. 

The amendment would have put Missouri in complicated territory with funding for the state’s Medicaid program, lawmakers concluded, and it ultimately failed. Wieland  later said it wasn’t his intent to ban the use of public funds on contraception, just to bar them from being used for abortions in the state. 

Quade said she anticipates seeing similar legislation in the future. 

“A few years ago during a special session, we saw a conversation around IUDs for Medicaid patients,” Quade said. “So that’s not a new thing. We’ve also seen legislation filed in the past going after ectopic pregnancies…. We absolutely can expect that stuff coming in the next legislative session because we’ve already seen it here in Missouri.” 

In the spring session, state Rep. Mary Elizabeth Coleman, R-Arnold, who recently won her primary for state Senate in Jefferson County, introduced a wide-ranging bill on abortion access. The bill would have criminalized behavior that aided and abetted someone trying to get an abortion, like reimbursing the cost of the care. Another bill introduced by Sen. Bill White, R-Joplin, would have criminalized bringing abortion-inducing drugs into the state. In the bill’s text, doing so could result in a Class B felony. None of the bills passed.

“Missouri has been eager to be on the cusp of the most cruel, the most restrictive abortion laws in the country,” Wales said, referring to those bills. 

Anti-abortion activists said they have no interest in prosecuting those seeking abortions, only those who can provide care. Missouri Right to Life, the state’s largest anti-abortion group, signed onto a letter affirming that the group does “not support any measure seeking to criminalize or punish women.” 

As a result of August primary successes, the Conservative Caucus, a group of senators who fought Republican leadership from the right throughout the 2022 session, announced they would disband due to increased voting power from the future legislators. Susan Klein, executive director of Missouri Right to Life, pointed to the announcement as an affirmation that the state is moving in what she said is the right direction. 

“​​We saw this as a resounding voice from across Missouri, that we want the Republicans to come back together and basically be a ‘conservative caucus’ of 24 Republicans in the Missouri Senate,” Klein told talk radio host Pete Mundo. “We want to defund Planned Parenthood. We have to address the issue of abortion drugs coming into Missouri.” 

Mallory Schwarz, the executive director of Pro-Choice Missouri, said she feels some lawmakers are using the issue as a platform without considering the consequences of their support. 

“We’ve seen the Conservative Caucus assert their power because they think now they have the votes,” Schwarz said. “We’ll see what happens in November. Ultimately, what’s clear is our state leadership is out of step with the actual needs, wants and beliefs of Missourians.” 

Quade said Democrats are readying for the legislative session’s next bill pre-filing period, which opens in December. 

“We will be filing a whole package around reproductive health care,” Quade said. “Not just simply an overturn of HB 126, but a whole slew of bills to try to provide some clarity, to provide protections for our hospital providers, all sorts of things.”