The cost of winning abortion rights in Missouri without expanding access

For a year, I’ve been writing and working with a larger coalition — What’s Next 4 Missouri — to ensure the story of Missouri’s fight for reproductive freedom is told accurately and rooted in justice. 

New abortion data backs our longstanding argument: that legal doesn’t mean accessible.

State data reported in The Missouri Independent, and subsequently backed up by a national report released last week by the Society of Family Planning (SFP), shows the $31.5 million investment last year to help pass the abortion-rights constitutional amendment yielded, according to the state health agency, fewer than 100 in-clinic abortions statewide this year — almost identical patient numbers in Missouri the year before Roe fell. 

SFP’s report is the first national state-by-state data drop that shows abortion numbers after November 2024, when Missouri and six other states voted to protect abortion rights. The chart is a stunning rebuke of campaign “strategy” and the $300 million invested nationwide. Access in states with newly amended constitutional protections, including in Missouri, which was the lone state in the abortion ballot cohort to claw back a total ban, saw almost no change in the number of people who could access an in-clinic abortion in their home state.

It might be why the well-funded anti-abortion right withheld money to fight ballot measures — spending money to keep things the same seems like a waste. In fact, the pro-abortion side outspent anti-abortion opposition eight to one nationwide in 2024. One should question such a lackluster response from the usually rabid anti-abortion zealots.

The Missouri Department of Health and Senior Services counted 80 in-clinic abortions in the past year. That’s nearly $400,000 per abortion in Missouri. In capitalist terms, that’s an abysmal return on investment that should be a warning shot across the bow for funders and donors even thinking about further investments in policies that mimic the failed Roe v. Wade framework. 

Beyond the dollars and cents of it all, what did this cost us in human capital? I’m thinking about the countless supporters who spent their free time collecting signatures and knocking doors to sell the same false hope that turned them out to volunteer. Will they answer the call next time? Did this erode the hope we cling to when we all diligently participate in democracy year after year?

After all, the same legacy organizations and institutions who made big asks of supporters are the same ones choosing inaction after securing their limited victory. Planned Parenthood, the only abortion provider in the state, has kept abortion appointments largely unavailable and self-imposed a gestational limit well before the state’s cut off.

More than 800 Missouri physicians who signed a letter in support of the reproductive freedom amendment last year are nowhere to be found providing abortion care while capacity is repeatedly cited as a challenge to expanding access.

The Missouri Abortion Fund is experiencing a decline in donations while footing the bill for out-of-state abortion care, which accounts for the majority of Missouri patients. Those lucky enough to get an appointment in-state still face an insurance ban leaders of last year’s campaign did not bother to challenge in their litigation strategy. What’s Next member, Right By You, took on parental involvement laws that effectively ban abortion for young people, expensive and time-consuming legal work that should never fall to already under resourced grassroots organizations.

One year later, the reality is abortion access looks much the same. It’s inaccessible. What’s worse is, as an early member of the campaign coalition, I know the focus was to turn out pro-choice Republicans to win limited abortion rights, ignoring the wider consequence of doing so. As a result, the hole in which we are trying to dig ourselves out of is deeper than ever.

Missouri’s anti-abortion supermajority grew, as these same majority “pro-choice” voters ushered in a second Trump presidency. 

What we must do next is openly analyze this with truth, transparency and accountability so it doesn’t repeat. Rote victory statements, in these dark times, are unproductive at best and threaten our collective fight for progress.

As an organizer, I’ve been trained never to engage the public without a call to action. Yet, these are the hardest times to come up with a clear ask when the problems we face are intricately weaved in a multitude of harms. 

So, I default to the basics. I call on allies to oppose efforts that uplift the Roe status quo. Insist on bodily autonomy. Resist the temptation to advocate in binary terms. It’s more than abortion. It’s about the freedom to parent, or not; birth your children with dignity and autonomy.

The right to end a pregnancy on your own terms. And liberation to make these decisions without punishment. You can’t have your freedom and your fascists too.

Use your power — whether it’s your voice, your money, your time or your work — to demand, fund, and support solutions that end pregnancy punishment. 

On the cusp of a midterm election, be ready to see the same hollow promises and find the guts to challenge it with your vote and your voice. Let’s lock arms with one another and demand better from the leaders and institutions we fund and elect to represent our interests.