Missourians decided to protect abortion rights in the state on Tuesday. That doesn’t mean it’s the end of the issue.

Republican legislators brought the abortion issue back to the ballot just two years after a citizen-led initiative to instill reproductive health rights in the state constitution passed 51.6% to 48.4%

But Amendment 3 failed on Tuesday, 55.5% to 44.5%. It would have banned abortion except in cases of rape and incest up to 12 weeks. Care would have been ensured for ectopic pregnancies, miscarriages, life of the mother and fetal anomalies.

The amendment also would have enshrined an existing ban on gender-affirming care for minors in the state constitution.

Instead, Missourians voted to keep all the protections from the 2024 amendment in place.

Mallory Schwartz, executive director of Abortion Action Missouri, said there are six clinics currently providing abortions across Missouri, including one in Columbia.

“We protected the patients who don’t have to cancel their appointments, who can count on being able to get care in their community,” Schwartz said.

Rep. Ed Lewis, R-Moberly, who created the amendment, said he was disappointed but not surprised with the results.

“Not enough Republicans came out voting,” Lewis said. “Democrats did, and they were motivated. And they got what they wanted; they’re still the party of killing innocent children.”

Gov. Mike Kehoe also expressed disappointment in the result for himself and his First Lady, Claudia Kehoe, treasurer of Her Health, Her Future, the organization backing the amendment. He pledged to continue the fight against abortion.

“As a father, grandfather and pro-life governor, I will continue to advocate for policies that support women, affirm the dignity and value of every life and protect children from irreversible gender transition intervention,” Kehoe said.

The “no” votes were split across the board. Some people voted no because they want access to abortion; others voted no because they thought the ban would not have gone far enough, and some voted no because they had already voted on abortion in 2024.

“Personally, I voted no on it because I believe that women’s reproductive healthcare should be protected, as all healthcare should be protected, and that should not have been the government’s job,” said Rep. Kathy Steinhoff, D-Columbia.

For Schwartz and her organization, the results were cause for celebration.

“My initial reaction was just gratitude and excitement,” Schwartz said. “Gratitude for the Missourians that made this campaign and this incredible victory possible.”

Schwartz said she believes voters’ frustration with lawmakers played a role in the outcome.

“I think that people were mad that they had to do it again,” Schwartz said. “I think that they felt that politicians were trying to overturn their vote and ignore what they demanded in ‘24, and disrespect their voice and their vote.”

Amendment 6, also on the ballot Tuesday, was approved by voters and will limit future actions by legislators to undo laws passed by voters.

In 2024, 2,981,681 people voted on Amendment 3. Tuesday, 2,114,237 people voted on the amendment. This is a difference of 867,444 people, likely due to the fact that 2024 was a presidential election year, which traditionally draws more voter participation.

Results showed that Saline, Greene, Jefferson and Cass counties changed from voting against abortion rights in 2024 to voting for abortion rights on Tuesday.

Statewide, 48.17% of registered voters cast ballots on Amendment 3 on Tuesday. In 2024, 67.26% of registered voters cast a ballot on the Amendment 3 protecting abortion rights.

Lewis said that the amendment would have been more likely to pass “if it had been on a, you know, not on a midterm where there was a blue wave.”

Her Health, Her Future, the campaign supporting Amendment 3, also pointed to the political environment and spending by opponents as factors in the defeat.

“Tonight is a loss for women, a loss for children and a loss for life,” campaign manager James Lawson said in a statement Tuesday. “The left poured tens of millions of dollars from out-of-state extreme leftists to defeat this amendment, and Missouri women and children will continue to suffer the consequences.”

The campaign claimed that more than $30 million in out-of-state spending went toward defeating the amendment. Despite the loss, Lawson said the campaign will continue advocating for restrictions on abortion.

“This campaign built a coalition of doctors, pastors, parents, and volunteers in every corner of this state, and that coalition is not going anywhere,” said Her Health, Her Future’s statement.

Missouri Right to Life’s State Political Action Committee also expressed disappointment in the results but said it would continue working with lawmakers on abortion policy.

“We will continue to educate the public on the dangers of Article I, Section 36 of the Missouri Constitution,” the committee said in a news release Wednesday. “We will also continue working with the Legislature to protect the innocent preborn persons in our state.”

Despite this pledge for continued efforts, Schwartz said Tuesday’s results reflect the work of abortion-rights organizers and volunteers who spent months campaigning across Missouri.

“I think it means everything for those folks that knocked doors and made calls and talked to their neighbors,” Schwartz said.

The results leave questions about how Republican lawmakers might approach abortion policy in the next legislative session.

Schwartz said the reproductive health protections in Missouri’s Constitution could prevent lawmakers from using some tactics they have pursued in the past, including additional licensing requirements and inspections for abortion providers.

“We are under no illusion that this work is over,” Schwartz said. “But we have an incredible movement for abortion rights and bodily autonomy and reproductive freedom in our state.”

The passage of Amendment 6 could also change how lawmakers approach future abortion legislation.

With Amendment 6, 80% of both chambers of the state legislature would have to approve altering a citizen-led amendment.

Lewis said the new requirement makes another legislature-led attempt to restrict abortion unlikely in the near future.

“I don’t see another amendment in the near future. I, you know, I don’t see how it’ll work,” Lewis said. “That was the most moderate proposal that could be put on the ballot that would pass.”

Steinhoff is more skeptical of the Republican agenda.

“The original Amendment 3 is going to stand in the Constitution, so it would be hard for them to override it a lot,” Steinhoff said, “but there’s always creative nuances, and we will just have to see what they’re willing to do.”