MARIES COUNTY — Missouri voters will decide on Nov. 3 whether to replace the reproductive freedom amendment approved in 2024 with a new constitutional amendment addressing abortion regulations and gender-transition treatments for minors.

Amendment 3 would allow broader restrictions to be placed on abortion, establish exceptions for certain medical circumstances and place prohibitions on specific gender-transition treatments for minors into the state Constitution. Several of the proposed restrictions are already addressed by existing Missouri laws, although court rulings have affected the enforcement of some provisions.

What a yes or no vote means

A yes vote on Amendment 3 would repeal the reproductive freedom amendment approved in 2024 and replace it with provisions permitting broader abortion restrictions and establishing constitutional prohibitions on certain gender-transition treatments for minors.

A no vote would leave the 2024 reproductive freedom amendment in place. Existing Missouri statutes, including the SAFE Act and parental consent requirements, would remain subject to their current provisions and applicable court rulings.

Missouri voters will decide the fate of the measure Tuesday, Nov. 3 during the general election.

What Amendment 3 would change

The proposal would repeal and replace Article I, Section 36, of the Missouri Constitution, which voters approved in November 2024. The existing amendment establishes a constitutional right to reproductive freedom, including decisions involving abortion, miscarriage care and other reproductive health matters.

Under the current provision, the state may regulate abortion after fetal viability, except when a health care professional determines it is necessary to protect the life or physical or mental health of the pregnant woman.

Fetal viability is determined through the professional judgment of a treating health care provider based on the circumstances of an individual pregnancy.

The proposed amendment would replace those protections with provisions allowing broader abortion restrictions and establishing exceptions for medical emergencies, fetal anomalies, rape and incest.

Abortions would be permitted in cases of rape or incest before 12 weeks’ gestation. The amendment would also allow abortions in qualifying medical emergencies and cases involving certain fetal anomalies throughout pregnancy.

A medical emergency is defined as a condition requiring an abortion to prevent death or substantial and irreversible physical impairment of a major bodily function, based on reasonable medical judgment.

A qualifying fetal anomaly is defined as a structural or functional abnormality that prevents survival outside the uterus.

The amendment also addresses treatment for miscarriages and ectopic pregnancies and would restrict abortions based on certain fetal diagnoses.

Additionally, it would restrict public funding for abortions, with specified exceptions, and prohibit fetal organ harvesting.

Existing Missouri abortion laws

Missouri already has statutes regulating abortion procedures, facilities and providers. However, several provisions have been affected by legal challenges following the approval of the 2024 reproductive freedom amendment.

State law includes requirements involving informed consent, parental consent for minors, facility licensing and medical emergencies.

Missouri Revised Statutes Section 188.028 generally requires parental consent before a minor may obtain an abortion, although it includes provisions allowing judicial authorization and exceptions for medical emergencies.

In October of 2025, a Jackson County court dismissed a challenge to Missouri’s parental consent requirements.

Other abortion-related regulations have faced different outcomes.

In August, the Missouri Attorney General’s Office reported that certain abortion-specific requirements were no longer enforceable, including facility licensing, hospital admitting privileges, emergency plans and waiting periods.

The proposed amendment would permit lawmakers to establish requirements addressing abortion facilities, inspections, medical examinations and provider qualifications.

These provisions would provide constitutional authority for restrictions that have been challenged under the existing reproductive freedom amendment. However, authorization to regulate does not necessarily mean every previously enacted requirement would automatically become enforceable.

Gender-transition treatments for minors

Amendment 3 also addresses medical treatments for minors experiencing gender dysphoria.

Missouri already restricts certain treatments under Senate Bill 49, enacted in 2023 and commonly known as the Missouri Save Adolescents from Experimentation Act, or SAFE Act.

The law prohibits gender-transition surgeries for minors and restricts the use of puberty blockers and cross-sex hormones for gender-transition treatment.

An exception permits certain minors who began receiving those medications before Aug. 28, 2023, to continue treatment.

The restrictions on puberty blockers and cross-sex hormones are scheduled to expire Aug. 28, 2027. The prohibition on gender-transition surgeries does not have the same expiration date.

The Missouri Supreme Court upheld the SAFE Act in 2026 against constitutional challenges.

Amendment 3 would place restrictions on gender-transition surgeries, puberty blockers and cross-sex hormones for minors into the state Constitution.

It would also eliminate the existing exception for minors who began treatment before the SAFE Act took effect.

The amendment includes exceptions for specified medical conditions unrelated to gender transition.

Perspectives on the amendment

Virginia Staabs, Democratic candidate for Missouri’s 16th Senate District, opposes Amendment 3, citing concerns about access to medical care and the potential effects of abortion restrictions on maternal health.

Staabs said the proposed medical emergency exceptions could create uncertainty for physicians treating women with serious pregnancy complications.

She questioned whether physicians would be able to intervene before a patient’s condition became life-threatening.

“That’s why the medical professionals are the ones who should be making the decision with the patient,” Staabs said.

Staabs also expressed concern that abortion restrictions could contribute to increased maternal mortality.

She cited a 40 percent increase in maternal deaths in states with abortion restrictions. However, The Advocate could not identify research establishing that specific increase as a consequence of abortion bans following the U.S. Supreme Court’s 2022 decision overturning Roe v. Wade.

Research examining abortion restrictions and pregnancy-related deaths has produced differing findings.

An April study published in JAMA (Journal of the American Medical Association) Network did not identify a statistically significant increase in pregnancy-associated mortality nationwide or in individual states following the Supreme Court decision. Researchers indicated that additional analysis would be necessary.

A May study published in the American Journal of Public Health reported an increase in pregnancy-associated deaths among 14 states with abortion bans but did not identify a detectable increase in maternal mortality. The researchers also acknowledged limitations in the available data.

Pregnancy-associated mortality includes deaths occurring during or after pregnancy regardless of cause, while maternal mortality refers to a narrower category of deaths related to pregnancy.

The Rev. Chris Slocum of First Baptist Church in Vienna supports Amendment 3, citing his religious beliefs concerning the protection of unborn life.

“We believe God. We’re made in the image of God. We want to protect life,” Slocum said.

Slocum acknowledged that the proposed amendment would continue to permit abortions under specified circumstances. Although he would prefer broader prohibitions, he said he supports the restrictions included in the measure.

“I think there’s a good heart behind individuals in that mindset, but we also have to be realistic within the world we’re in and what can be done,” he said.

Slocum also emphasized the availability of community resources for pregnant women and families, including adoption services, pregnancy resource centers and local assistance programs.

He said his church provides assistance with food, clothing, utilities and other household needs.

With reporting by Jeremiah Yonemura