Dr. Jennifer Smith remembers canvassing to overturn Missouri’s abortion ban back in 2024. Now she’s spending her weekends knocking doors in her white coat to make sure her home state doesn’t ban abortion again.
Smith, an OB-GYN, had seen what happened to her patients after Roe v. Wade was overturned and a “trigger” law immediately went into effect banning virtually all abortions in the state.
“You could see how scared people were to just consider being pregnant in the state of Missouri,” she said. “I had husbands feel the need to tell me that I should save their wives if something should happen in the pregnancy. And that’s a pretty terrifying place to be.”
Even before the fall of Roe, abortion access in Missouri was extremely limited. The state is home to some of the most vociferous abortion opponents in the country. Among them are Republican Sen. Josh Hawley, who has made himself a leading figure in the national push to ban abortion pills; his wife Erin, a top attorney at the Alliance Defending Freedom; and Ed Martin, a stop-the-stealer who helped craft the GOP’s fetal personhood platform in 2024.
Missouri is also one of the most dangerous states for pregnant women, with maternal mortality rates much higher than most of the country. And once the trigger ban was enacted, the medical-legal landscape became even darker for both patients and doctors: OB-GYN residency applications in the state declined by 25 percent. “As a physician, it feels like we have to be afraid that if we take care of patients in the way that we normally would, that we might go to prison for that,” Smith said.
People who needed abortions were forced to spend time and money on travel, and made to experience some of the worst moments of their lives isolated in an unfamiliar place. Some drove for hours on end while in danger of sepsis or hemorrhage just to reach a hospital that would treat them. “I had a patient who was pregnant twice in one year, and both times her baby had a chromosomal abnormality,” Smith remembered. “Twice she and her husband had to make the most difficult decision a parent can make: to end the pregnancy. And twice they had to leave the state to get the care they needed, away from their home, their doctor, everything familiar.” In 2024, Smith canvassed for a referendum to repeal the state’s near-total ban.
Missouri voters passed that referendum—called Amendment 3—with 51.6 percent of the vote. The first state to enact a “trigger ban” became the first state to reject that ban at the ballot box. But that wasn’t the end of the story: even after the ban was overturned, Missouri implemented dozens of restrictions on how abortion clinics could operate—ensuring that in much of the state, abortion was legal in theory but not in practice. Meanwhile, Republican lawmakers worked to craft another attempt at a full-scale ban.
Now, Smith is back to knocking doors in her white coat. This time, she’s asking people to vote no on 2026’s Amendment 3—which, despite sharing a number with the 2024 amendment, does the opposite. And unlike the first Amendment 3, this one was initiated by the legislature, not by citizens.
“We already won the battle for abortion here in Missouri, and that is why they added gender-affirming care.”
“We have voters that we believe are confused,” said Stop The Ban campaign manager Alessia Modjarrad. “They consider themselves for abortion, for reproductive freedom—but the language is confusing, and they’re hypothetically voting yes, but really they should be voting no.”
In 2025, Republican lawmakers introduced the current Amendment 3 proposal to reestablish a constitutional abortion ban and overturn the 2024 referendum. To increase their chances of success, they adopted a strategy right out of the Trump 2.0 “Kamala is for they/them” playbook: including language in the ballot measure that would change the Missouri constitution to “prohibit gender transition procedures for minors,” banning doctors from providing puberty blockers and hormone therapy to treat kids with gender dysphoria.
Trans youth health care is already illegal in Missouri under a law enacted in 2023. But you wouldn’t know that from Amendment 3’s marketing.
Some of the same people who pushed to ban gender-affirming care for Missouri kids in 2023 are now fighting to enshrine that ban in the state’s constitution. Prominent among them is Jamie Reed, a former Washington University Transgender Center clinic employee turned prolific speaker on the anti-trans circuit. “If we talk to people about the trans part of this amendment,” Reed reportedly told a room full of St. Louis County Republicans in September, “we can get it to pass.”
Reed—who spent much of the past 3 years touring state legislatures to push trans care bans nationwide—also became the face of a marketing campaign by the Her Health, Her Future PAC, a group run by Missouri Gov. Mike Kehoe’s wife, Claudia. “I worked in a gender transition clinic, and saw how children are manipulated into undergoing irreversible surgeries,” Reed said. Reed has, notably, failed to back up these statements in court, has had her characterizations of what went on at the clinic where she worked disputed by patients and parents, and is not a medical professional.
But her words are backed by $5.3 million in advertising money, and abortion opponents are counting on her story to resonate with voters: in one 2023 poll, a majority of Missourians supported heavily restricting transition-related care for young people.
“The opposition is not talking about abortion because they know they will lose,” said state Rep. Elizabeth Fuchs of St. Louis. “We already won the battle for abortion here in Missouri, and that is why they added gender-affirming care.”
State Rep. Wick Thomas, Missouri’s first nonbinary state legislator, says they’re faced with colleagues wanting to bring up trans kids every day of the week. Republicans don’t necessarily see abortion as a winning issue anymore, even in a conservative state flooded with pro-life money. But fearmongering about trans kids, Thomas said, might still win.
“I’ve had people tell me they’re only attacking the trans community right now because it works, and once it doesn’t, they’ll stop.”
“I think they knew just from the last vote that they couldn’t win on abortion alone, and that because the anti-trans attacks have historically done well for them, they decided to wrap them together, and they’re hoping that that would push it over the edge,” Thomas said.
“I’ve had Republican colleagues tell me, you know, not all of them actually even care about this,” Thomas said. They said that some of their colleagues are “secretly fairly supportive” of trans people. But 53 anti-trans bills were introduced by members of Missouri’s Republican supermajority in the past year. Total abortion bans, by contrast, are not at all popular.
“I’ve had people tell me they’re only attacking the trans community right now because it works, and once it doesn’t, they’ll stop,” Thomas said. “But when you have people’s lives in your hands, that’s an unsatisfying thing to hear.”
Smith and her daughter joined a group of medical professionals to canvas St. Louis’ Shaw neighborhood. Their materials focused on abortion—if they were asked about trans people, one organizer told me, they would just say that it was already illegal for kids to transition medically. In a liberal community, they found support: an older man ready to vote against the ban, who just needed help finding his polling place; a group of college kids day-drinking on a balcony, chanting “NO ON THREE! NO ON THREE!” and drunkenly congratulating Smith on being a doctor.
“I hope they remember that later,” Smith said. The latest polling shows a razor-thin margin on Amendment 3, with likely no voters just one percentage point ahead of those who plan to vote yes. The measure’s opponents will need all the votes they can get.