Missouri measure would replace 2024 abortion protections

A proposed constitutional amendment on Missouri’s Nov. 3, 2026, ballot would repeal the reproductive-health-care protection voters approved in 2024 and replace it with provisions that allow abortion to be restricted to specified cases. The replacement would also address abortion regulation and consent for minors, and gender-transition care for minors. It would take effect only if voters approve it.

The Secretary of State lists the measure, Amendment 3, as certified for the statewide general-election ballot. Referred by the 103rd General Assembly as HCS HJR 73, it would repeal Article I, Section 36, and adopt a proposed Section 36(a). The 2024 amendment, also called Amendment 3, passed with 52% of the vote in favor and 48% opposed, according to Axios Kansas City. The two amendments are separate ballot measures.

How the proposed abortion provisions differ

The 2024 constitutional provision protects reproductive-health-care rights, including abortion through fetal viability. The proposed replacement would allow abortion to be restricted to cases of medical emergency or fetal anomaly, or to cases of rape or incest when the abortion occurs before 12 weeks’ gestation. The measure would therefore replace the existing constitutional protection with a framework permitting those restrictions; it would not simply add exceptions while leaving Section 36 in place.

The official fair-ballot language separately says the proposal would continue access to medical care for medical emergencies, ectopic pregnancies and miscarriages. It would authorize legislation regulating abortion providers and facilities, require informed and voluntary consent, and address parental or judicial consent for minors. It would also limit public funding of abortions to specified circumstances. These provisions are proposed, not current law.

Provisions involving minors

The proposal would address gender-transition procedures for people under 18, including surgeries, cross-sex hormones and puberty-blocking drugs, with exceptions for specific medical conditions. If approved, those specified prohibitions and exceptions would be placed in the state constitution.

Missouri already has statutory restrictions on knowingly performing gender-transition surgery on people under 18 and on knowingly prescribing or administering cross-sex hormones or puberty-blocking drugs for gender transition to them, subject to statutory exceptions. The statutory subsection covering the drugs is set to expire Aug. 28, 2027; the surgery restriction is in a separate subsection without that expiration date. The proposed constitutional provisions are distinct from those existing statutes.

The measure also addresses consent for minors seeking abortion care. Its official ballot language says abortion consent must be informed and voluntary and refers to parental or judicial consent for minors. The proposal would place that framework in the replacement constitutional provision if approved.

Vote and fiscal estimates

The official fiscal language says state governmental entities estimate no costs or savings. Greene County estimates a possible increase in tax revenue of an unknown amount, while other local governmental entities estimate no costs or savings.

Axios reported that proponents frame the measure as protecting children, while opponents criticize the gender-transition provisions as a way to roll back reproductive-rights protections. Those are attributed campaign positions, not established findings about how widely either view is held. Missouri voters are scheduled to decide the measure on Nov. 3, 2026. If it is rejected, this measure would not repeal the 2024 constitutional provision.