Missouri Amendment 3, the Prohibit Abortion and Gender Transition Procedures for Minors Amendment, is on the ballot in Missouri as a legislatively referred constitutional amendment on November 3, 2026.
A “yes” vote supports amending the Missouri Constitution to:
- repeal the constitutional right to reproductive freedom, which voters ratified in 2024;
- prohibit abortions except in cases of “medical emergency, fetal anomaly, rape, or incest,” and permit abortions in cases of rape or incest only through 12 weeks of gestation;
- prohibit gender transition surgeries for minors, as well as the prescription or administration of cross-sex hormones or puberty-blocking drugs to minors, with an exception for treatments “unrelated to the purpose of a gender transition;” and make other changes.
A “no” vote opposes amending the Missouri Constitution, keeping the existing constitutional right to reproductive freedom, and not adding provisions that prohibit abortion and gender transition surgeries and procedures.
Commentary
Before I get into the actual bill itself, I want to express my opinion here. The 2024 Amendment Three, which was passed by the Voters of the State of Missouri opens with the following term:
Abortion
2. The Government shall not deny or infringe upon a person’s fundamental right to reproductive freedom, which is the right to make and carry out decisions about all matters relating to reproductive health care, including but not limited to prenatal care, childbirth, postpartum care, birth control, abortion care, miscarriage care, and respectful birthing conditions.
3. The right to reproductive freedom shall not be denied, interfered with, delayed, or otherwise restricted unless the Government demonstrates that such action is justified by a compelling governmental interest achieved by the least restrictive means. Any denial, interference, delay, or restriction of the right to reproductive freedom shall be presumed invalid…
This wsa the will of the people, and while the demographics show that a majority of the State, county and district wise, voted against the 2024 Amendment three bill, it still managed to gather 51.6 percent of the votes to approve the Amendment. Where the problem lies is that only three areas approved the Amendment, Kansas City, Columiba, and St Louis Missouri. This is one of the reasons that the Republicans wanted to pass the Amendment to make that all ‘citizen’ initiated amendment pass ALL Districts in the State of Missouri, because the three heaviest populated areas of the State passed the Amendment against the will of the rest (48.4%). Interestingly enough, those three areas are Democrat strongholds in the State. The people, however, by majority, spoke.
I am not a supporter of Abortion when it is used as a form of birth control. When there is no medical reason, no moral reason (such as incest or rape) to terminate the pregnancy, just simple laziness and lack of responsibility. There is sufficient access to birth control methods. There is the pill, and there is the shot. There are devices that can be used, some long term, some temprorary. And there are condoms. Yes, i’m not a big fan of condoms either, but they are an option to prevent pregnancy.
HOWEVER – It is not MY place to tell a woman what she can or cannot do with her body. It is not my place to deny her the right to terminate an unwanted pregnancy. But on the same breath, let me say that it SHOULD NOT be my responsibility as a Taxpayer ti cover the cost of such abortions. The financial burden should fall DIRECTLY on the woman and the man who got her pregnant.
If there needs to be an amendment to section 36a, it should be that Federal, State and Local funding of Abortion Services should be terminated and the cost put on Insurance or the individuals responsible for the pregnancy.
Gender Transition
I stand in full support of the restrictions that this Amendement would set regarding Gender Transition on those under the age of 18. Separate from the Abortion issue, I would be tempted to vote in favor of this bill. But it’s not, and I will not pass what I feel is going against the voters of this State on the matter of Abortion to pass a bill protecting children from making what could be a devastatingly bad decision, or being pushed into it by their … parents or others. After they are eighteen, they will hopefully have a better grasp on their sexuality and the world around them, and make a reasonable decision (don’t hold your breath). But after they turn eighteen, they are of majority, they are not in full ownership of their lives and they can make all the mistakes they want and suffer any backlash that may come from it.
Again, the Taxpayers SHOULD NOT be on the hook for hte costs of these theraapies or Surgeries. These are elective surgeries, so Insurance should not be on the hook either, and I don’t need this level of stupidity (in my opinion) driving up the cost of my healthcare insurances.
How would Amendment 3 change abortion policies in Missouri?
This amendment would repeal Amendment 3, which was passed by voters in 2024. It amended the state constitution, providing for the fundamental right to reproductive freedom, including abortion.
The amendment would then add a new section that would prohibit abortion, except in cases of medical emergency, fetal anomaly, rape, or incest. For cases of rape and incest, the abortion could only be performed before 12 weeks. It would prohibit abortions based on a fetal disability diagnosis, except in cases of fetal anomaly. It would require parental or guardian consent for minors seeking an abortion and prohibit fetal organ harvesting. The amendment would also provide for the ability of a woman to access healthcare in cases of miscarriage and ectopic pregnancy.
State Sen. Brad Hudson (R-33), who supports HJR 73, said, “From constituents and individuals that I’ve been talking to about this issue, they want another opportunity to weigh in on this. They don’t feel like that they were given an option in Amendment 3 that accurately reflects who they are and where they are on the life issue.”
Margot Riphagen, president and CEO of Planned Parenthood Great Rivers Action, who opposes the measure, said, “The majority of Missourians want to make their own decisions about health care without interference from prying politicians … We will not stand for more political games at the expense of the thousands of patients in Missouri who could finally access care they need without crossing state lines. Missouri voters will once again send a clear message that enough is enough.”
Abortion is currently legal in Missouri up to the point of fetal viability, which is defined in Missouri law as “that stage of fetal development when the life of the unborn child may be continued indefinitely outside the womb by natural or artificial life-supportive systems.”
How would Amendment 3 change state policy related to transgender medical procedures for minors?
The amendment would also prohibit gender transition surgeries for minors under 18, and prohibit the prescribing of cross-sex hormones or puberty-blocking drugs to minors under 18. This does not include the use of surgeries, drugs, or hormones to treat children born with medically verifiable disorders of sex development, or to treat any infection, injury, disease, or disorder unrelated to the purpose of gender transition.[1]
Currently, gender transition procedures for minors are statutorily prohibited in Missouri.
What states provide a constitutional right to abortion?
Missouri was one of 14 states that placed a constitutional amendment on a ballot to amend the state constitution to provide for the right to an abortion. The first three states to pass these amendments were California, Michigan, and Vermont in 2022, the same year that Roe v. Wade was overturned following the Dobbs v. Jackson Women’s Health Organization U.S. Supreme Court decision. Out of the 14 states, voters passed right-to-abortion amendments in 11 of them, and rejected amendments in three — Florida, Nebraska, and South Dakota. After 2022, voters in one state — Nebraska — approved a measure to limit the timeframe during which an abortion can be performed.
With Missouri’s Amendment 3, this will be the first time voters will decide to repeal a right-to-abortion amendment.
How did this amendment get on the ballot?
In order for the state legislature to refer a constitutional amendment to the ballot in Missouri, a simple majority vote is required in each chamber. The amendment was introduced by State Rep. Ed Lewis (R-6) as House Joint Resolution 73 (HJR 73). HJR 73 passed the House by a vote of 103-51 on April 17, 2025, and was agreed to in the Senate by a vote of 21-11 on May 14, 2025.
Ballot title
The official ballot title is as follows:[5]
“Shall the Missouri Constitution be amended to:
- Repeal the 2024 voter-approved Amendment providing reproductive healthcare rights, including abortion through fetal viability; Allow abortions for rape and incest (under twelve-weeks’ gestation), emergencies, and fetal anomalies; Allow legislation regulating abortion; Ensure parental consent for minors’ abortions; Prohibit gender transition procedures for minors?
Constitutional changes
The ballot measure would repeal Section 36 of Article I of the Missouri Constitution, and add a new section, Section 36a. The following text would be added and struck-through text would be deleted:
Section 36(a).
1. The state’s duty to protect public health and welfare includes protecting the integrity and ethics of the medical profession. The state’s interest in regulating the practice of medicine is even greater in areas of medical and scientific uncertainty or in areas that raise grave moral and ethical concerns, including abortion and gender transition procedures.
2. An abortion may be performed or induced upon a woman in cases of medical emergency, fetal anomaly, rape, or incest. In the case of abortions performed or induced in cases of rape or incest, the abortion may be performed or induced no later than twelve weeks gestational age of the unborn child.
3. The general assembly may enact laws that regulate the provision of abortions, abortion facilities, and abortion providers to ensure the health and safety of the pregnant mother. These laws shall include, but not be limited to, laws requiring physicians providing abortion care to have admitting privileges at a nearby hospital; laws requiring facilities where abortions are performed or induced to be licensed and inspected for clean and safe conditions and adequate instruments to treat any emergencies arising from an abortion procedure; laws requiring physicians to perform a sufficient examination of the woman to determine the unborn child’s gestational age and any preexisting medical conditions that may influence the procedure; and laws requiring ultrasounds to be performed only by physicians or licensed medical technicians.
4. No abortion shall be performed or induced upon a woman based on a prenatal diagnosis, test, or screening indicating a disability in an unborn child, except in cases of a fetal anomaly.
5. No public funds shall be expended for the purpose of performing, inducing, or otherwise assisting any abortion, except in cases of medical emergency, rape, or incest, as otherwise authorized by law.
6. Except in cases of a medical emergency in which consent cannot be obtained, no abortion shall be performed or induced upon a woman without her voluntary and informed consent, given freely and without coercion. In the case of a minor under the age of eighteen years who is not emancipated, no person shall knowingly perform or induce an abortion, except in cases of a medical emergency in which consent cannot be obtained, unless the attending physician has obtained:
(1) the written consent of the minor and a parent or legal guardian; and(2) documentation of the consent is retained in the minor’s medical record. Licensed medical physicians shall be required to provide women with medically accurate information. The general assembly may enact laws to provide for the right of a minor to consent to an abortion as granted by a court order.
7. Fetal organ harvesting after an abortion is not permitted under any circumstances.
8. A woman’s ability to access health care in cases of miscarriages, ectopic pregnancies, and other medical emergencies shall not be infringed by the state.
9. No gender transition surgeries shall be knowingly performed on children under eighteen years of age, and no cross-sex hormones or puberty-blocking drugs shall be knowingly prescribed or administered for the purpose of gender transition to children under eighteen years of age. The provisions of this section shall not apply to the use of such surgeries, drugs, or hormones to treat children born with a medically verifiable disorder of sex development or to treat any infection, injury, disease, or disorder unrelated to the purpose of a gender transition.
10. Any action challenging the validity of any state law relating to reproductive health care shall be brought in the Circuit Court of Cole County, Missouri. If a pleading, written motion, or other paper drawing into question the constitutionality of a state statute does not include the state, one of its agencies, or one of its officers or employees in an official capacity, the party bringing the action shall file a notice of constitutional question and serve it on the attorney general and the attorney general shall have the right to intervene in the litigation.
11. The general assembly shall have the authority to enact laws to carry out the provisions of this section.
12. As used in this section, the following terms mean:
(1) “Cross-sex hormones”, testosterone, estrogen, or other androgens given to an individual in amounts that are greater or more potent than would normally occur naturally in a healthy individual of the same age and sex;
(2) “Fetal anomaly”, a structural or functional abnormality in the unborn child’s gestational development that would make life outside the womb impossible;
(3) “Fetal organ harvesting”, collection of fetal tissue, organs, or fluids, including any biological material, for the purpose of selling or collecting for scientific purposes, but shall not include the utilization of fetal tissue, organs, or fluids to determine the cause or causes of any anomaly, illness, death, or genetic condition of the unborn child, the paternity of the unborn child, or for law enforcement purposes;
(4) “Gender transition surgery”, a surgical procedure performed for the purpose of assisting an individual with identifying with and living as a gender different from his or her biological sex;
(5) “Medical emergency”, a condition that, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate termination of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman. A medical emergency shall include, but not be limited to, an ectopic pregnancy at any point following the diagnosis of such and treatment for a miscarriage;
(6) “Puberty-blocking drugs”, gonadotropin-releasing hormone analogues or other synthetic drugs used to stop luteinizing hormone secretion and follicle stimulating hormone secretion, synthetic antiandrogen drugs to block the androgen receptor, or any other drug used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition;(7) “Reasonable medical judgment”, a medical judgment that would be made by a reasonably prudent physician, knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.
13. All provisions of this section are severable. If any provision of this section is found by a court of competent jurisdiction to be unconstitutional or unconstitutionally enacted, the remaining provisions of this section shall be and remain valid.
Section 36.
1. This Section shall be known as “The Right to Reproductive Freedom Initiative.”
2. The Government shall not deny or infringe upon a person’s fundamental right to reproductive freedom, which is the right to make and carry out decisions about all matters relating to reproductive health care, including but not limited to prenatal care, childbirth, postpartum care, birth control, abortion care, miscarriage care, and respectful birthing conditions.
3. The right to reproductive freedom shall not be denied, interfered with, delayed, or otherwise restricted unless the Government demonstrates that such action is justified by a compelling governmental interest achieved by the least restrictive means. Any denial, interference, delay, or restriction of the right to reproductive freedom shall be presumed invalid. For purposes of this Section, a governmental interest is compelling only if it is for the limited purpose and has the limited effect of improving or maintaining the health of a person seeking care, is consistent with widely accepted clinical standards of practice and evidence-based medicine, and does not infringe on that person’s autonomous decision-making.
4. Notwithstanding subsection 3 of this Section, the general assembly may enact laws that regulate the provision of abortion after Fetal Viability provided that under no circumstance shall the Government deny, interfere with, delay, or otherwise restrict an abortion that in the good faith judgment of a treating health care professional is needed to protect the life or physical or mental health of the pregnant person.
5. No person shall be penalized, prosecuted, or otherwise subjected to adverse action based on their actual, potential, perceived, or alleged pregnancy outcomes, including but not limited to miscarriage, stillbirth, or abortion. Nor shall any person assisting a person in exercising their right to reproductive freedom with that person’s consent be penalized, prosecuted, or otherwise subjected to adverse action for doing so.
6. The Government shall not discriminate against persons providing or obtaining reproductive health care or assisting another person in doing so.
7. If any provision of this Section or the application thereof to anyone or to any circumstance is held invalid, the remainder of those provisions and the application of such provisions to others or other circumstances shall not be affected thereby.
8. For purposes of this Section, the following terms mean: (1) “Fetal Viability”. the point in pregnancy when, in the good faith judgment of a treating health care professional and based on the particular facts of the case, there is a significant likelihood of the fetus’s sustained survival outside the uterus without the application of extraordinary medical measures. (2) “Government”, a. the state of Missouri; or b. any municipality, city, town, village, township, district, authority, public subdivision or public corporation having the power to tax or regulate, or any portion of two or more such entities within the state of Missouri[6]
