Missouri abortion restrictions go on trial as high-profile proceedings begin

More than a year after Planned Parenthood sued to overturn Missouri’s abortion ban, the issue finally heads to trial this week in Kansas City.

Circuit Judge Jerri Zhang will preside over the case in Jackson County. The outcome could shape access to abortion services and any restrictions on the procedure that remain.

St. Louis Public Radio editor Jonathan Ahl spoke with reporter Sarah Fentem about what to expect from the high-profile proceedings.

Jonathan Ahl: So it’s been a while since we last checked in on Amendment 3 — bring us up to speed. What’s going on?

Sarah Fentem: Amendment 3 passed in November of 2024, and it put the right to an abortion in the Missouri Constitution.

But abortions didn’t start immediately. Instead, Planned Parenthood — which is pretty much the only provider in Missouri besides hospitals that provides abortions — sued the state, not only to overturn the state’s ban but also to overturn laws and provisions that govern abortion facilities.

Planned Parenthood representatives said those restrictions are tantamount to a ban because they place so many restrictions on getting the procedure, and thus, they’re unconstitutional.

In February 2025, a Kansas City judge named Jerri Zhang agreed with most of Planned Parenthood’s arguments and put a temporary hold on most of those restrictions while this saga plays out in the courts. But she didn’t place a hold on all of those restrictions.

In the meantime, providers have said that those remaining restrictions are still too onerous and keep them from providing most abortions, particularly medication abortions.

Legal wrangling over which restrictions are still in play has meant abortion has been restricted and then allowed, and clinic employees have spoken of "whiplash" as they attempt to stay in compliance with the latest court decisions.

And that means in the midst of all this Sturm und Drang, fewer than 200 abortions took place in the state of Missouri, according to the latest data from state health officials. That’s provisional data and will probably go up as more reports come in, but it still shows that the procedure is still relatively rare in Missouri despite the passage of Amendment 3.

Ahl: Can you give an example of some of these restrictions?

Fentem: Missouri for years put laws, restrictions and rules in place to govern abortion facilities. And those include requirements that providers issue pelvic exams before abortions and have admitting privileges at hospitals within a certain distance.

Another rule that’s kept providers from offering some types of abortions is the requirement they have something called a complication plan. Missouri law says health centers that provide medication abortions must have a state-approved plan in place. Planned Parenthood argues that makes access really tenuous because the state health department can change the rules any time it wants.

Ahl: And so after more than a year, the trial date is finally here. What can we expect?

Fentem: The trial is scheduled for two weeks in Kansas City. And it's a bench trial, which means the judge will decide the verdict, not a jury.

In a nutshell, the state’s lawyers will argue that these restrictions are necessary because abortion providers are medical providers, and they’re needed to keep patients safe.

According to pretrial briefs, the state says Planned Parenthood has a financial incentive to push for deregulated abortion procedures, and the court should wait for affected patients to bring challenges to these laws instead.

Ahl: So that’s the state’s position. What do you think Planned Parenthood’s lawyers will say?

Fentem: The organization’s attorneys have argued that these laws are discriminatory. According to court documents, its lawyers say these requirements are difficult, if not impossible, for most of the health centers in the state to follow and that they don’t align with medical standards of care. Another argument they’ll likely raise is that providers who perform other similar procedures don’t have to comply with these sorts of laws.

Planned Parenthood Great Rivers CEO Margot Riphagen has used the example of vasectomies; she says although the organization also provides that procedure, the state “doesn’t ask the same questions around vasectomies as they do around abortion.” She said that was just one way to prove these requirements are politically, not medically, motivated.

Ahl: So what can we expect in the future?

Fentem: I think it’s fair to say after around a decade of reporting on abortion in Missouri, the fight over access has never really been settled. Even if the judge rules in Planned Parenthood’s favor, it’s possible the state could appeal that decision.

That’s not even considering another ballot initiative that will be put to voters later this year that could repeal the constitutional right to an abortion in Missouri. So … watch this space.