Abortion rights advocates are divided as Missouri Legislature pursues new laws

ST. LOUIS — For many abortion rights advocates in Missouri, passing Amendment 3 last November was to have been a defining moment. Access to abortion access would be restored. Years of ever-tightening state restrictions would end.

It hasn’t turned out that way.

Nearly three months after the amendment passed with 51% of the vote, no abortions have been provided in the state.

Advocates blame the groups that pushed Amendment 3 for taking a path of least resistance to get the ballot measure passed — one that’s opened the door to litigation and new attempts by the Missouri Legislature to restrict abortions. 

“This has decimated the coalition around reproductive health rights and justice in this state,” said Stephanie Kraft Sheley, a lawyer and founder of Right By You, a youth-focused text line connecting Missourians to abortion or birth care.

“We are so fractured, and it’s so deeply harmful, and it’s going to take such a reckoning to come back from,” she said.

Advocates who pushed for a tougher amendment against government interference say experience shows it was necessary. 

In 2019, three years before Roe v. Wade was overturned, Missouri almost became the first state in the nation without an abortion clinic when the state health department refused to renew the license for Planned Parenthood’s facility in St. Louis.

The fight played out in courts over nearly a year, with a state administrative judge’s final ruling that the Planned Parenthood clinic provided safe and legal abortion care and met the licensing requirements.

When it came time years later to let Missouri voters decide whether to enshrine the right to an abortion into the state’s constitution, some advocates saw a chance to write an amendment that was much stronger in guaranteeing abortion access than Roe ever was.

But others at the negotiating table over the language feared Missourians weren’t ready to approve that.

The side wanting to play it safe won out — the final ballot language for Amendment 3 provided the right to “reproductive health care,” including abortion and birth control, but allowed the Missouri government to regulate abortions after “fetal viability.”

The amendment would leave it up to the courts to decide whether the state’s long list of abortion regulations violated the new constitutional language.

The disagreement over the ballot language, some say, has left the abortion rights advocacy effort in Missouri divided and weakened.

The clearest sign of that division played out at the St. Louis area Planned Parenthood Great Rivers and its advocacy arm, Planned Parenthood Great Rivers Action.

As many as nine senior staff members there resigned amid arguments over the ballot initiative, including CEO Yamelsie Rodriguez, Vice President of Communications Bonyen Lee-Gilmore and Vice President of Advocacy Vanessa Wellbery.

Dr. Colleen McNicholas, Great Rivers chief medical officer, joined the exodus on Monday, the same day that Margot Riphagen — hired a year ago to lead Great Rivers’ effort to get Amendment 3 passed — was announced as the new CEO.

Those who worked with McNicholas say she was the front line of defense against the Legislature and a staunch believer in abortion access, and she quietly advocated against Amendment 3.

“She may be probably the only one remaining doctor I’ve seen in the state who truly understands the nuance and complexities of providing reproductive health care, including abortion, in a state like Missouri,” Lee-Gilmore said.

Others argue that Great Rivers remains a strong advocate. Just getting Amendment 3 on the ballot — an effort that drew on 1,800 volunteers collecting more than 380,000 signatures in just three months — shows the abortion rights movement in Missouri is broader and stronger than ever, they say.

On Wednesday, that work continued when more than 200 advocates descended on the Capitol to demand that legislators stop efforts to limit or repeal Amendment 3.

“Partners disagree all the time, and working through those agreements is what makes a coalition strong,” said Mallory Schwarz, executive director of Abortion Action Missouri, which helped lead the amendment campaign.

“We’re talking about folks who walked away from the table when the conversations got tough,” Schwarz said. “And what we’re left with is a coalition that will never walk away, and that is committed to do whatever it takes to get to the future we believe in.”

Including ‘fetal viability’

Amendment 3 went into effect Dec. 5, but abortions are not yet accessible in Missouri as a lawsuit by Planned Parenthood providers seeks to throw out state laws and regulations that prevent them from operating.

While a judge has since struck down the state’s abortion ban — a 2019 statute that went into effect as soon as Roe was overturned in 2022 — some licensing regulations remain in place as the case makes its way through the courts, preventing any clinics from opening.

In 1984, state data shows Missouri recorded more than 20,000 abortions at 26 clinics. In 2020, 167 abortions were performed at the sole clinic in St. Louis.

A few of the regulations that led to clinic closures included having to meet expensive surgical center building codes, despite not performing surgeries; requiring abortion patients to meet with the same doctor 72 hours apart; and requiring providers to have admitting privileges at local hospitals.

The St. Louis clinic had been the only one to meet these requirements, but that didn’t matter when the state health department tried to refuse renewing its license.

Soon after, abortion rights groups agreed to launch a statewide ballot initiative to restore abortion access in Missouri. Lee-Gilmore said she, McNicholas and other staffers argued for wording that would do nothing less than ensure the right to access abortion throughout pregnancy without government interference.

But other groups — including Abortion Action Missouri, the ACLU of Missouri, as well as Planned Parenthood’s and ACLU’s national affiliates and nonprofit Fairness Project which helps states with ballot measures — felt the measure would have a better chance at passing if it allowed the Legislature to enact laws regulating abortion after “fetal viability.”

“We said look, this is not going to be adequate, they are going to this language, and they are going to use it to ban abortion. We said it then, a year-and-a-half ago when this language was being drafted, and now that is exactly what is coming true,” Lee-Gilmore said.

Both chambers of the Legislature have made passing new abortion restrictions a priority this legislative session. Republican lawmakers have also already filed dozens of bills to overturn or weaken Amendment 3, including efforts to further define fetal viability.

Fetal viability depends on many complex factors, of which gestational age is only one, according to the nation’s leading association of obstetricians that write guidelines for patient care. Because viability isn’t always possible to definitively predict, the association “strongly discourages the inclusion of viability in legislation or regulation.”

Women seek abortions later in pregnancy because they discovered a serious fetal diagnosis, are experiencing health emergencies, didn’t know they were pregnant and/or faced barriers to obtaining care earlier in pregnancy, according to the association.

Wellbery, who resigned from Great Rivers in March of last year just before the affiliate would come out publicly supporting Amendment 3, said she couldn’t support language that suggests a point in pregnancy when the government can take control away from patients and their clinicians.

McNicholas, meanwhile, co-founded The Raven Lab for Reproductive Liberation, whose mission is to develop a sustainable and nationwide strategy to “build and grow support for truly unrestricted abortion access.”

McNicholas did not respond to requests for comment about her decision to quit. She announced her resignation on social media, stating, “My greatest hope is that many of you will join me and the many brave advocates who see this moment in our country as an opportunity to step up and challenge the conventional wisdom that has brought our progressive causes to its knees.”

Schwarz praised Riphagen for bringing Great Rivers back into the coalition backing the amendment, which she claims ended the division in advocacy efforts — other than “a handful of people who are disgruntled.”

“This is a strong and united coalition working together, and I’m grateful to have Planned Parenthood at the table and as a leader in the coalition,” Schwarz said. “We are exactly where we should be.”

‘More work to be done’

Riphagen said she inherited a team at Great Rivers that was enthusiastic about getting Amendment 3 passed and is now putting all their effort into protecting it.

She and Schwarz say some of Missouri’s most onerous abortion restrictions have already been thrown out, including the 72-hour waiting period and biased counseling requirements.

Hospitals can also provide abortions to patients experiencing complications during pregnancy without the threat of criminal penalties. Pregnant women across the country have reported being turned away from emergency rooms in states with abortion bans, and some have died.

“Even though there’s more court battles that have to play out, and even though there’s more work to be done,” Schwarz said. “We did a huge and transformative thing very quickly.”

Wellbery, who still lives in St. Louis and is involved in advocacy work for family planning researchers and clinicians, said not everyone is celebrating Amendment 3 as a win.

“Is a win sustained access for everyone, or are we looking at a win that is just at the ballot box in one election?” Wellbery said. “I think that’s something that advocates will really needing to be grappling with.”

Wellbery hopes that organizing efforts going forward will focus on the most marginalized, whom she says were compromised in Amendment 3.

“I think it is important as advocates to really evaluate when we need to admit that there was a strategic misstep,” she said, “and that is the first step toward actually doing something better that is in the service of Missouri communities.”

Riphagen said she is “open to having conversations” and further strengthening coalitions with Planned Parenthood. Fundamentally, she said, all advocates share the same goal of expanding abortion access.

“When we have conversations about shared goals and how we get there from where we are, we can build that brighter future that I know we will have,” she said. “Where we are is looking forward. You can’t build on things only looking backwards.”

Lee-Gilmore called leaders in the coalition backing the amendment “too arrogant” to acknowledge any lessons learned or mistakes made.

“We know that liberation was never going to be won through the big, pink wing of the Democratic Party, which is Planned Parenthood and the ACLU,” Lee-Gilmore said. “So now we are looking at our own chess pieces to figure out how to better organize the people of Missouri to try and forge a path forward?”