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President Trump's agenda could limit reproductive health care and abortion access in Missouri

Signs for and against Amendment 3, the Missouri abortion rights ballot measure that voters passed in November 2024.
Vaughn Wheat
/
The Beacon
Signs for and against Amendment 3, the Missouri abortion rights ballot measure that voters passed in November 2024.

Missourians voted for both President Donald Trump and to restore abortion access in November's election. In his first term, the Trump administration appointed Supreme Court justices who would overturn Roe v. Wade, slashed Title X funding, and defunded health care clinics.

As President Donald Trump begins his second term, the landscape around reproductive health in the United States is dramatically different from when he first took office in 2017.

Trump appointed three U.S. Supreme Court justices during his first term, paving the way for the overturn of Roe v. Wade in 2022. Now, as he takes office again, reproductive rights advocates are preparing for Trump and his allies at the federal and state levels to take action against things like abortion, family planning services and funding for certain programs.

In Missouri, Republican lawmakers are searching for ways to deal with the fallout after voters restored abortion access in November. Amendment 3 reinstated access to abortion up to fetal viability and ensured protections for patients seeking abortions and the medical professionals who provide them.

Despite passage of the amendment, Missourians cannot currently access abortion procedures because challenges to the amendment and its wording are still working through the courts. Although a judge recently ruled that Missouri’s previous abortion ban violated the newly amended state Constitution, licensing requirements that block Planned Parenthood from providing abortions are still in place.

As the courts consider these questions, state lawmakers are looking to place definitions on terms like “fetal viability” or are looking for ways to restrict or repeal Amendment 3.

As they wait for arguments in state courts, federal courts continue to review cases that pertain to reproductive rights, which could have consequences in states where abortion is restricted.

How could Trump’s stance on abortion affect Missouri? 

Trump was never transparent on the campaign trail about his stance on abortion. He was most frequently asked whether he would throw his weight behind a national abortion ban. He said in October he would veto a national ban, because it should be left to states.

But while the nation reelected Trump, seven states voted to reinstate or protect abortion access in November.

A top concern among abortion rights supporters is how the second Trump administration will handle Medicaid funding for reproductive health. This month, U.S. Sen. Josh Hawley introduced legislation to block any federal funds from going to Planned Parenthood or any organization that provides or refers people for abortion care.

During Trump’s first term, the Department of Health and Human Services allowed states more authority over which providers can draw on Medicaid funding. States took that as a signal to restrict funding to Planned Parenthood, and Missouri lawmakers passed legislation that prevents Planned Parenthood clinics from participating in Medicaid.

While Planned Parenthood still operates in Missouri, it currently does not receive Medicaid reimbursements to provide care for low-income patients.

What are abortion rights supporters watching when it comes to reproductive rights?

Critics point to Project 2025, a policy wish list written by the Heritage Foundation, a powerful conservative think tank. Project 2025 calls for a number of changes to restrict abortion or to federal funding that could interfere with reproductive health in the states.

While Project 2025 was not an official party platform and Trump denied connection with the policy proposals, the Heritage Foundation is influential in Congress and state legislatures across the country. The group was one of the driving forces behind Missouri’s ban on gender-affirming care for minors.

Chief among the concerns from reproductive health care advocates is access to the abortion drug mifepristone.

According to the Guttmacher Institute, which tracks reproductive health policies, a combination of mifepristone and misoprostol was used in 63% of all abortions in 2023, up from 53% in 2020.

Missouri’s Planned Parenthood chapters are suing to restore access to abortion in Missouri. In their lawsuit, they challenged the telehealth restrictions in place in Missouri.

“In many states, lots of parts of the country, people receive high-quality, safe abortion services direct to their homes through telehealth,” said Planned Parenthood Great Plains CEO Emily Wales in November. “We think Missourians should have the same type of care.”

A number of changes have been suggested to restrict access to the drugs. Project 2025 proposes policies that would effectively end telehealth access to the abortion method. Others have advocated for the Food and Drug Administration to revoke its approval of the drugs, which has been in place since 2000.

Some proposed paths to cut access to mifepristone include using the 1870s Comstock Act, which bars mailing materials that can be used to induce an abortion. The law hasn’t been enforced for decades, but some abortion opponents want to use it to block abortion medications.

Trump said in August that he would not enforce the law, but his allies have pointed to the law as another potential path to restrict access to abortion.

Restricting treatment in emergencies 

Republicans have also pushed to restrict access through the courts by challenging the Emergency Medical Treatment and Active Labor Act (EMTALA), a 1980s law requiring hospitals to provide treatment to emergency room patients. Stabilizing treatment could include an abortion, even in states that outlaw the procedure, because EMTALA is a federal law.

In 2024, Idaho and the Biden administration were in the courts arguing over Idaho’s abortion law and how it interacts with federal policies. Idaho argued that EMTALA could not preempt its abortion ban, because under federal law medical providers are directed to do everything in their power to protect the life of the pregnant person and the fetus.

But the Biden administration argued for a broader definition in the courts: EMTALA requires hospitals to provide stabilizing treatment, including abortion, to preserve the health of a pregnant person, presumably a lower threshold to meet than providing an abortion to save the mother’s life.

The Supreme Court dismissed the case and refused to rule on it, sending it back to lower courts and leaving the door open for further challenges to how EMTALA may interact with states and their abortion laws.

But Missouri gained national attention due to one hospital’s interpretation of the policy under the state’s abortion ban.

In August 2022, two months after the state’s abortion ban went into effect, a pregnant woman sought emergency care at a Joplin hospital for bleeding, leaking amniotic fluid and cramping. She had a history of miscarriage and had recently been diagnosed with deep vein thrombosis.

Her water had broken early. Her treatment options for stabilizing care under EMTALA included induced labor or continued observation. She chose to induce labor, although the hospital wanted to continue observing for continued deterioration of her health before inducing labor. She later was transferred to hospitals in Kansas, and eventually, Illinois.

What we know about reproductive rights from Trump’s first term 

While it isn’t yet clear how the Trump administration will approach abortion and other reproductive health issues, reproductive rights advocates are watching for him to repeat some of his actions from his first term.

Most notably, federally funded Title X clinics are watching to see if Trump will slash their funding, like he did in his first term.

The family planning program provides free or low-cost contraception for those who could otherwise struggle to access it.

In 2019, the Trump administration implemented a new rule that prohibited any Title X providers from mentioning abortion care to patients. At the time, six state governments and Planned Parenthood, an abortion provider in many states, left the Title X network, eliminating access to their family planning services, including contraception, STI and cancer screenings and certain counseling services. The policy defunded over 1,000 Title X clinics across the country.

Family planning clinics, health departments and other safety net health care providers are tapped into the Title X network. The program went from 4 million patients in 2017 to 1.5 million patients in 2020, according to the Guttmacher Institute. The policy also blocked any Title X provider from sharing spaces with any abortion activities.

The Biden administration undid these changes to Title X, but it is expected that Trump will reinstate them in his second term.

Experts also assume that Trump will mimic his first term by reinstating a global gag rule, which would defund organizations that provide abortion information or services in other countries.

Since Trump took office earlier this week, a reproductive health website established by the Biden administration’s HHS has been taken offline. The website included information about access to contraceptives, abortion medication and procedures and emergency rights.

This story was originally published by The Beacon, a fellow member of the KC Media Collective.

Copyright 2025 KCUR 89.3

Meg Cunningham