Missouri voters approved a measure to add an abortion rights protection to their state constitution, a decision that could reverse the state’s near-total ban on the procedure, according to a projection by Decision Desk HQ.

Missouri would be the first state to overturn a near-total abortion ban. 

Missouri has long been one of the nation’s most hostile states to abortion rights. Even before Roe v. Wade was overturned, a long history of state restrictions on the procedure had eliminated all but one abortion clinic in the state. In 2021, the last full year before Roe’s fall, only 150 abortions took place in Missouri, the lowest tally in the country.

“By saying yes to this powerful language, voters have demanded the return of the essential human rights and freedoms they lost after Roe was overturned,” said Nancy Northup, president of the Center for Reproductive Rights.

Abortion opponents — including the state’s Republican secretary of state — had fought for months to keep the measure, known as Amendment 3, from appearing on the Missouri ballot. Those efforts ultimately failed. 

Even with Amendment 3’s passage, restoring abortion access to Missouri could be a long, difficult process. Abortion providers will have to individually challenge the state’s numerous abortion restrictions in court. In the past, Missouri lawmakers have refused to comply with voter-backed policy changes — notably a 2020 measure expanding eligibility for Medicaid — until forced to by courts.

“Today’s vote is the first step to end the abortion ban that has harmed countless patients and targeted providers,” said Emily Wales, the head of Planned Parenthood Great Planes Votes.

Abortion opponents in the state signaled they will continue to challenge the abortion rights measure. Mary Elizabeth Coleman, a conservative state senator who sought to keep the measure of Missouri’s ballot, said the election “won’t be the last time Missourians vote on so-called ‘reproductive rights.’”

“We stand ready to help defend the rights of Missouri’s parents, women, children, and babies, against the assaults that are planned by the proponents of Amendment 3,” said Mary Catherine Martin, senior counsel at the Thomas More Society, an anti-abortion legal organization that represented Coleman.