Missouri Judge Blocks Abortion Ban—But Clinics Still Can’t Reopen

Last month, Missourians voted to add the right to abortion until viability into their state constitution—making their state one of ten to enshrine abortion rights since the Supreme Court overturned Roe v. Wade.

But simply having the constitutional right to abortion does not alone change anything on the ground: The courts must enforce this right by affirming that anti-abortion laws violate states’ newly amended constitutions. A ruling this week by a Missouri judge shows just how fraught it is to depend on the courts for abortion access—even after the people, by popular vote, demand it.

Within 24 hours of the November election where Missouri voters passed the state’s abortion-rights amendment, Planned Parenthood sued to ask the courts to enforce this change. On Friday, a state judge weighed in for the first time: She temporarily blocked the state’s near-total abortion ban. But she left in place several anti-abortion laws that will continue to prevent abortion providers from serving patients.

In a partial preliminary injunction issued on Friday, Jackson County Judge Jerri Zhang temporarily allowed the state’s licensure law to remain in place, giving the Missouri Department of Health and Senior Services the power to withhold licenses from abortion clinics if their hallways, rooms, and doors don’t meet the architectural requirements of ambulatory surgical centers. The hallway width requirement is a classic example of what’s known as a TRAP law, standing for “targeted regulation of abortion providers.” Back when the United States still had a national right to abortion, passing TRAP laws that were near-impossible to comply with was the strategy of choice for the anti-abortion movement in its quest to shut down clinics. Missouri’s TRAP laws were so effective at achieving this goal that in the years before Roe was overturned, just one abortion clinic in the state was still in operation—providing only around 100 abortions per year at a Planned Parenthood facility in St. Louis.

“While Planned Parenthood stands ready to start providing abortions in Missouri again as soon as the Court permits, the abortion restrictions remaining in effect—including Missouri’s medically unnecessary and discriminatory clinic licensing requirement—make this impossible,” Planned Parenthood Great Plains said in a statement after Zhang’s ruling. “The vast majority of Planned Parenthood health centers cannot comply with the medically irrelevant size requirements for hallways, rooms, and doors.”

In her order, Zhang said she was allowing the licensure law to remain in place while the lawsuit continues because it involves rules for facilities rather than “the right of individuals seeking care”—without addressing the reality that the facility rules were designed to undercut the right to abortion. Either Zhang has been duped, or she’s playing along: “The Court finds there may be a compelling governmental interest in licensing abortion facilities in this manner,” she wrote in her order.

Now, no Missouri abortion clinics have a license. To get one, they’ll have to apply to some of the same state officials who fought this year’s abortion rights ballot initiative tooth and nail, earning rebukes from the court system. Their track record runs deep: Back in 2019, the state health department did its utmost to close the St. Louis Planned Parenthood clinic, declining to renew its license and imposing shifting requirements that providers likened to harassment, my former colleague Marisa Endicott reported.

Ultimately, the clinic was only able to keep its doors open thanks to court orders and an administrative hearing officer. “The licensure requirement also leaves Planned Parenthood facilities at the whim of anti-abortion officials in Missouri, who can continue to weaponize the licensure process to limit abortion access, as they have done for decades,” Planned Parenthood Great Plains said in its Friday statement.

There is a silver lining to the ruling: Doctors in hospitals who need to perform emergency abortions will no longer be operating under the threat of state punishment.

“Hospital-based providers across the state are able to provide more care today than they could yesterday now that the fear of criminal prosecution has been removed,” said ACLU of Missouri litigation director Gillian Wilcox in a statement on Saturday. Zhang also granted the preliminary injunction blocking other TRAP laws: a 72-hour waiting period for abortions, a requirement that patients take abortion medication in the presence of a doctor, and a rule stating that abortion providers have admitting privileges at a hospital within 15 minutes’ drive of a clinic, among others.

There is also another threat coming down the line. While the legal battle continues over which Missouri anti-abortion laws can coexist with the new abortion-rights amendment, state legislators are weighing their own ballot initiatives for the next election cycle. That includes a proposal to ask voters to re-impose a blanket abortion ban, and another that would shift “fetal viability,” generally understood as the time when a fetus could survive outside the pregnant person’s body, from around 24 weeks gestation to the 6-week mark of pregnancy—when embryos measure around the size of a pea and have almost no organs.