Vice President Kamala Harris has lost no time blaming former President Donald Trump for the death of a single mother in Georgia after hospital doctors, working under the constraints of an abortion ban, delayed treating her catastrophic infection.

The story of Amber Nicole Thurman’s death in August 2022—and its connection to the six-week abortion ban enacted in Georgia the month before she died—was first reported by ProPublica’s Kavitha Surana. While doctors, patients, and reproductive justice advocates have long warned that abortion bans were causing profound disruptions and delays in healthcare for pregnant women, Thurman’s is the first death to come to public attention.

“This young mother should be alive, raising her son, and pursuing her dream of attending nursing school,” Harris said in a statement reported by the Associated Press. “Women are bleeding out in parking lots, turned away from emergency rooms, losing their ability to ever have children again. Survivors of rape and incest are being told they cannot make decisions about what happens next to their bodies. And now women are dying.”

“This young mother should be alive, raising her son, and pursuing her dream of attending nursing school.”

“These are the consequences of Donald Trump’s actions,” Harris added.

Later on Tuesday, during a interview moderated by the National Association of Black Journalists and WHYY public radio station in Philadelphia, Harris once again drew a link between Thurman’s death and Trump. “Over 20 states have passed what I call ‘Trump abortion bans,’ because I understand how we got here,” Harris told an audience of journalism students from historically Black colleges and universities. “The former president handpicked three members of the United States Supreme Court with the intention they would undo the protections of Roe v. Wade. They did as he intended, and in state after state, laws have been passed criminalizing health care providers.”

The doctors who delayed Thurman’s care were operating under these laws, Harris pointed out. “It appears the people who should have given her health care were afraid they’d be criminalized after the Dobbs decision came down,” she said.

According to ProPublica, Georgia’s ban on abortions after six weeks affected Thurman in multiple ways. When Thurman discovered she was pregnant with twins in July 2022, she was just over the gestational limit. Because the 28-year-old medical assistant could not get an abortion near where she lived, she had to drive four hours with a friend to North Carolina. Then, stuck in traffic, she missed her appointment for a surgical abortion using a technique called dilation and curettage (D&C), so the clinic instead gave her medication to end her pregnancy and sent her home. The distance meant that days later, when Thurman began experiencing a rare complication from the medication abortion—her body hadn’t expelled all the fetal tissue, putting her at risk of a dangerous infection—she couldn’t go back to the provider for a free D&C. Only when her condition deteriorated did she end up going to a hospital outside Atlanta.

There, her blood pressure falling and organs failing, Thurman was diagnosed with “acute severe sepsis.” But physicians waited 20 hours to operate. The hospital and doctors did not respond to ProPublica’s requests for comment. But the delays mirror many other stories about abortion bans leading to dangerous disruptions in pregnancy care since the Supreme Court overturned Roe. Physicians afraid of being prosecuted have raised alarms about the laws’ hard-to-interpret exceptions: How close to death does a pregnant patient have to be in order for them to perform emergency abortion?

Thurman ultimately died in the operating room. A Georgia state committee tasked with reviewing maternal deaths found that the delay in providing the D&C had a “large” impact on her death, and they deemed it “preventable,” according to ProPublica.

Harris’ attention to Thurman’s story is no surprise given her reputation as a forceful defender of abortion rights on the campaign trail and in her debate against Trump. But her attention to pregnancy-related deaths—which are far more common in the United States than in other high-income countries—dates back years. In the Senate, Harris focused on reducing maternal mortality for Black women like Thurman, who are 2.6 times more likely to die of pregnancy-related causes than white women, according to 2022 CDC data. In 2018, she sponsored a resolution recognizing “Black Maternal Health Week” and introduced the Maternal CARE Act to create a grant program to address racial bias in obstetrics and gynecology. As vice president, she pushed efforts to expand postpartum Medicaid coverage from 60 days to 12 months.

“For years, I have worked to make sure our country treats maternal mortality as the national crisis it is,” Harris wrote in 2022, prefacing a 50-point plan to use government agencies to lower maternal deaths. “I am proud to lead our Administration’s efforts to address this issue.”

Reproductive justice advocates have been warning for more than two years that the end of Roe v. Wade would lead to surge in maternal mortality among patients denied abortion care—and that the increase was likely to be greatest among low-income women of color. Now, a new report by ProPublica has uncovered the first such verified death. A 28-year-old medical assistant and Black single mother in Georgia died from a severe infection after a hospital delayed a routine medical procedure that had been outlawed under that state’s six-week abortion ban.

Amber Nicole Thurman’s death, in August 2022, was officially deemed “preventable” by a state committee tasked with reviewing pregnancy-related deaths. Thurman’s case is the first time a preventable abortion-related death has come to public attention since the Supreme Court overturned Roe, ProPublica‘s Kavitha Surana reported.

Now, “we actually have the substantiated proof of something we already knew—that abortion bans kill people.”

Now, “we actually have the substantiated proof of something we already knew—that abortion bans kill people,” said Mini Timmaraju, president of the abortion-rights group Reproductive Freedom for All, during a call with media. “It cannot go on.”

Thurman is almost certainly not the only person to have died as a consequence of an abortion ban, even if her case is the first to be officially confirmed. As ProPublica noted, that’s because investigations of maternal deaths often don’t happen until years later:

Committees like the one in Georgia, set up in each state, often operate with a two-year lag behind the cases they examine, meaning that experts are only now beginning to delve into deaths that took place after the Supreme Court overturned the federal right to abortion.

Earlier this year, the New Yorker reported on the story of Yeniifer Alvarez-Estrada Glick, a 29-year-old woman in Texas who died in July 2022 from complications of a high-risk pregnancy. In that case, medical records did “not suggest any discussion of the fact that an abortion could have alleviated the additional strain that the pregnancy placed on her heart,” the New Yorker reported.

According to ProPublica, Thurman had decided to get an abortion after learning she was pregnant with twins. But the very day she passed the six-week mark of her pregnancy, Georgia implemented a ban forbidding abortion after six weeks’ gestation—as the Supreme Court allowed states to do when it overturned Roe earlier that summer. So Thurman traveled four hours to an abortion clinic in North Carolina, where abortions were then allowed past 20 weeks. There she was given mifepristone and misoprostol, a two-drug regimen used to end pregnancies.

A few days after she took the pills, Thurman’s pain became excruciating, and she was bleeding through a pad every hour. Complications from abortion pills are rare, but sometimes patients require a procedure called dilation and curettage, or D&C, to remove remaining fetal tissue from the uterus that could lead to life-threatening sepsis. The North Carolina clinic would have performed the D&C for free if Thurman lived closer, ProPublica said. Instead, after vomiting blood and passing out at home, Thurman was brought to the hospital in the Atlanta suburbs, where doctors noted signs of an infection. According to ProPublica,

The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.

But because D&Cs can be used to perform abortions, physicians operating under an abortion ban can be slow to provide them even for miscarriages and other emergency situations, as illustrated in a recent report on post-Roe disruptions to pregnancy care in Louisiana. Not until 2 p.m. the day after Thruman entered the hospital was she brought for surgery. She died in the operating room. The Georgia maternal mortality review committee found that if a D&C had been performed earlier, there was a “good chance” her death could have been prevented, ProPublica reports.

“These devastating bans did not only block Amber, and many others, from accessing abortion care in her state, they also delayed the routine life-saving care she later needed, leaving her to suffer and die,” Timmaraju said during the press call on Monday.

While every state abortion ban contains exceptions to save the life of the pregnant person, uncertainty among medical providers over exactly when doctors can step in without fear of being prosecuted has led to delays in medical care for pregnant woman across the country, with devastating consequences.

On the call with reporters, leaders of reproductive justice organizations pointed to the way bans and delays in emergency medical care for pregnant people disproportionately impact Black women. Black women are about 2.6 times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention.

“Reproductive justice is not just about abortion access, but also about the broader right to quality, comprehensive, full-range, culturally humble care, life saving health care for all of us,” said KR Redman, executive director of SPARK, a reproductive justice group in Georgia. “Amber’s case is just an example of the ongoing systemic negligence that continues to claim the lives of Black folks.”

More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

When Project 2025 staffer and former Trump White House personnel chief John McEntee tried to score points on social media on Thursday by denying that women were “bleeding out” due to abortion bans, he probably didn’t expect them to reply to him directly.

“Can someone track down the women Kamala Harris said are bleeding out in parking lots because Roe v. Wade was overturned?” McEntee asked in a TikTok video filmed at a restaurant as he dipped fried food into sauce.

“Don’t hold your breath,” he added, smirking.

“I’m right here,” replied Carmen Broesder, a mother living in Idaho, which enacted a trigger law after the fall of Roe, a making it a felony for doctors to provide an abortion unless it was necessary “to prevent the death of the pregnant woman.”

In a TikTok video of her own, Broesder recalled how hospital staff turned her away from the ER three times during an excruciating 19-day miscarriage. She said she was repeatedly denied a procedure to remove tissue from the uterus—a procedure known as dilation and curettage (D&C) that is also used in abortions—and that they gave her just one dose of pain medication in 19 days. “I blacked out in my hallway due to blood loss,” she recounted.

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In June, the Supreme Court gave Idaho hospitals the green light to perform emergency abortions to protect pregnant people’s health, as well as their life—but the ruling is temporary while the lower courts reconsider the issue. But the problem isn’t confined to Idaho. In Oklahoma, Jaci Statton developed heavy bleeding, dizziness, and weakness from a molar pregnancy, a condition in which a fertilized egg does not develop into a fetus. For more than a week, she told NPR, doctors denied her treatment, and she was transferred to three different hospitals. Ultimately, she had to drive three hours to an abortion clinic in Kansas to get an D&C.

“The record shows that, as a matter of medical reality, such cases exist,” Justice Elena Kagan wrote in a concurring opinion in the Idaho case. “Hospitals in Idaho have had to airlift medically fragile women to other States to receive abortions needed to prevent serious harms to their health. Those transfers measure the difference between the life-threatening conditions Idaho will allow hospitals to treat and the health-threatening conditions it will not.” 

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life.”

According to Rolling Stone, Broesder’s severe blood loss during her miscarriage caused erratic blood pressure and a stress response that led her to be diagnosed with a heart condition she said could lead to a heart attack if she gets too excited or upset. “I have to deal with these side effects for the rest of my life because of abortion laws,” Broesder said in her video.

Broesder’s experience is a clear illustration of what Vice President Kamala Harris was talking about when she responded to former president Donald Trump’s bizarre claim during the debate that “every legal scholar” wanted Roe v. Wade overturned. “Pregnant women who want to carry a pregnancy to term, suffering from a miscarriage, being denied care in an emergency room because the health care providers are afraid they might go to jail, and she is bleeding out in a car in the parking lot—she didn’t want that,” Harris said. “Her husband didn’t want that.”

McEntee, the founder of a conservative-only dating app, has a large following on TikTok, where he posts snarky and often offensive quips about race and gender designed to tickle his MAGA audience. But his video garnered thousands of first-person responses, many telling stories about severe medical complications after pregnant people were denied care.

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life,” one commenter said.

“My daughter. Nearly lost her life after she miscarried triplets that didn’t expel her body & 3 hospitals wouldn’t remove them,” another replied.

“I’ve been anemic on and off since my weeks-long miscarriage,” wrote yet another commenter. “Three hospitals refused to give me a DNC or pill protocol. Unimaginable pain and distress.”

And so it goes, on and on, for more than 19,000 comments as of Saturday.

More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

When Project 2025 staffer and former Trump White House personnel chief John McEntee tried to score points on social media on Thursday by denying that women were “bleeding out” due to abortion bans, he probably didn’t expect them to reply to him directly.

“Can someone track down the women Kamala Harris said are bleeding out in parking lots because Roe v. Wade was overturned?” McEntee asked in a TikTok video filmed at a restaurant as he dipped fried food into sauce.

“Don’t hold your breath,” he added, smirking.

“I’m right here,” replied Carmen Broesder, a mother living in Idaho, which enacted a trigger law after the fall of Roe, a making it a felony for doctors to provide an abortion unless it was necessary “to prevent the death of the pregnant woman.”

In a TikTok video of her own, Broesder recalled how hospital staff turned her away from the ER three times during an excruciating 19-day miscarriage. She said she was repeatedly denied a procedure to remove tissue from the uterus—a procedure known as dilation and curettage (D&C) that is also used in abortions—and that they gave her just one dose of pain medication in 19 days. “I blacked out in my hallway due to blood loss,” she recounted.

@geekynerdbitchcarmen

#stitch with @Date Right Stuff

♬ original sound – Date Right Stuff

In June, the Supreme Court gave Idaho hospitals the green light to perform emergency abortions to protect pregnant people’s health, as well as their life—but the ruling is temporary while the lower courts reconsider the issue. But the problem isn’t confined to Idaho. In Oklahoma, Jaci Statton developed heavy bleeding, dizziness, and weakness from a molar pregnancy, a condition in which a fertilized egg does not develop into a fetus. For more than a week, she told NPR, doctors denied her treatment, and she was transferred to three different hospitals. Ultimately, she had to drive three hours to an abortion clinic in Kansas to get an D&C.

“The record shows that, as a matter of medical reality, such cases exist,” Justice Elena Kagan wrote in a concurring opinion in the Idaho case. “Hospitals in Idaho have had to airlift medically fragile women to other States to receive abortions needed to prevent serious harms to their health. Those transfers measure the difference between the life-threatening conditions Idaho will allow hospitals to treat and the health-threatening conditions it will not.” 

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life.”

According to Rolling Stone, Broesder’s severe blood loss during her miscarriage caused erratic blood pressure and a stress response that led her to be diagnosed with a heart condition she said could lead to a heart attack if she gets too excited or upset. “I have to deal with these side effects for the rest of my life because of abortion laws,” Broesder said in her video.

Broesder’s experience is a clear illustration of what Vice President Kamala Harris was talking about when she responded to former president Donald Trump’s bizarre claim during the debate that “every legal scholar” wanted Roe v. Wade overturned. “Pregnant women who want to carry a pregnancy to term, suffering from a miscarriage, being denied care in an emergency room because the health care providers are afraid they might go to jail, and she is bleeding out in a car in the parking lot—she didn’t want that,” Harris said. “Her husband didn’t want that.”

McEntee, the founder of a conservative-only dating app, has a large following on TikTok, where he posts snarky and often offensive quips about race and gender designed to tickle his MAGA audience. But his video garnered thousands of first-person responses, many telling stories about severe medical complications after pregnant people were denied care.

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life,” one commenter said.

“My daughter. Nearly lost her life after she miscarried triplets that didn’t expel her body & 3 hospitals wouldn’t remove them,” another replied.

“I’ve been anemic on and off since my weeks-long miscarriage,” wrote yet another commenter. “Three hospitals refused to give me a DNC or pill protocol. Unimaginable pain and distress.”

And so it goes, on and on, for more than 19,000 comments as of Saturday.

Reproductive rights advocates in Missouri have beaten back a last-ditch effort by Republican officials to stop voters from having their say on abortion in November. On Tuesday afternoon, the Missouri Supreme Court ordered that a proposed amendment to enshrine abortion rights in the state constitution will remain on this year’s ballot.

The ruling ensures that Missourians will have the opportunity to vote on Amendment 3, which would establish a right to “reproductive freedom”—defined as the ability to make and carry out one’s own decisions about contraception, abortion, and healthcare during pregnancy. If approved, the amendment will set a high legal bar for how the state can regulate abortion prior to “viability”—the difficult-to-pinpoint moment when a fetus becomes likely to survive outside the uterus. After viability, the measure would let the state ban abortion, with exceptions to protect the life and health of the pregnant patient.

The decision caps a roller-coaster of a year for Missouri reproductive-rights advocates, who faced hurdle after hurdle to get the measure on the November ballot. Supporters gathered more than 380,000 signatures this spring, circumventing a legislature dominated by hard-line abortion foes who passed the state’s current, near-total abortion ban. A St. Louis University/YouGov poll of 900 likely voters in mid-August found that 52 percent supported Amendment 3 and 34 percent opposed it.

“Today’s decision is a victory for both direct democracy and reproductive freedom in Missouri,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the group behind the amendment, said in a statement. “This fight was not just about this amendment—it was about defending the integrity of the initiative petition process and ensuring that Missourians can shape their future directly.”

Ballot initiatives have become a central part of the strategy to restore and expand abortion rights in the post-Roe v. Wade era. They’re also key to Democrats’ efforts to turn out voters in battleground states in this year’s tight presidential election. Abortion rights are popular, even in solidly red states; the pro-choice side has won all seven abortion-related measures on state ballots since 2022.

That’s led Republican officials in GOP-dominated states including Arkansas, Florida, and Nebraska to pull out all the stops this year to prevent abortion-rights measures from getting to the ballot in the first place—filing lawsuits, delaying or invalidating petitions, and spreading misinformation.

In Missouri, Tuesday’s ruling comes in response to a last-minute lawsuit by two Republican state lawmakers, Rep. Hannah Kelly and Sen. Mary Elizabeth Coleman, working with anti-abortion activists and lawyers from the Thomas More Society, a law firm aligned with conservative Catholics. They argued that Missouri Secretary of State Jay Ashcroft should never have certified Amendment 3 because it did not specify which state laws it would repeal. (Missouri law requires initiative petitions to “include all sections of existing law or of the constitution which would be repealed by the measure.”) In a court filing, they claimed that the Amendment 3 campaign “defrauded potential signers” and that the measure “would have far-reaching effects,” including on Missouri’s rules on human cloning and single-sex bathrooms.

Amendment supporters responded that no state laws would be automatically repealed. Instead, advocates would have to file lawsuits challenging anti-abortion laws, with judges making the final decisions about which ones violate the new constitutional amendment. “This is another example of someone flailing, trying to gum the works of a campaign that has serious momentum,” said Mallory Schwartz, executive director of Abortion Action Missouri, part of the pro-Amendment 3 coalition. “What they’re really doing is trying to deny people access to direct democracy.” 

The Missouri Supreme Court’s decision overturns a surprise ruling by Cole County Circuit Judge Christopher Limbaugh last Friday evening declaring that the vote on the amendment should be canceled—though he left time for an appeal. Judge Limbaugh, a cousin of the late conservative talk radio host Rush Limbaugh, was appointed to the bench by his former boss, Republican Gov. Mike Parson, barely five weeks ago.

Ashcroft defended his certification in a hearing before Limbaugh. But following the Friday ruling, Ashcroft sent the abortion-rights campaign a letter announcing that he was decertifying Amendment 3 himself. “On further review in light of the circuit court’s judgment, I have determined the amendment is deficient,” he wrote.

In its Tuesday ruling, the Missouri Supreme Court ordered Ashcroft to recertify Amendment 3 for the ballot, ruling that the deadline for him to issue a certification decision had passed.

For Ashcroft and other Missouri Republicans, the decision is yet another rebuke in a long and exhausting campaign to keep the amendment off the ballot. In at least four previous lawsuits, Missouri courts have slapped down state officials’ attempts to interfere with the amendment.

First, state Attorney General Andrew Bailey, who is running for reelection, held up the initiative for months by pushing a baseless theory that the initiative could cost the state billions in federal Medicaid funding and declining to rubber-stamp a cost estimate prepared by the state’s auditor. After a legal battle, the Missouri Supreme Court ordered Bailey to stop stonewalling.

Then last fall, Kelly and Coleman—the same legislators behind the latest lawsuit—seized on Bailey’s phony theory about Medicaid funding and sued the state auditor over his cost estimate. They too were slapped down by the courts, which found the cost estimate “fair and sufficient.”

Meanwhile, Ashcroft—an outspoken abortion opponent whose job requires him to craft neutral summaries of ballot initiatives—issued summaries claiming the measure would permit “dangerous, unregulated, and unrestricted abortion.” Last October, an appeals court ruled those summaries were “replete with politically partisan language.” A circuit court judge completely rewrote them.

But Ashcroft didn’t learn his lesson. Last month, on the same day he certified the amendment for the ballot, he issued “fair ballot language” to be posted at polling places that made a slew of false claims, including that the measure would prohibit legal recourse against “anyone who performs an abortion and hurts or kills the pregnant women.” Last Thursday, Cole County Circuit Judge Cotton Walker threw out Ashcroft’s description, calling it “unfair, insufficient, inaccurate and misleading.”

Tuesday’s Supreme Court ruling is a crucial win for the fight to expand abortion rights in Missouri, which has some of the most restrictive laws in the country. Even before the Supreme Court overturned Roe v. Wade, only one clinic remained open in the state, providing fewer than 100 abortions annually. Hours after the fall of Roe, state officials invoked a dormant law making it a felony to provide abortion in virtually all cases.

Missouri isn’t the only place where state officials have been making last-ditch efforts to block or blunt voter referendums on abortion. On Monday, the Nebraska Supreme Court heard arguments in a trio of lawsuits over dueling amendments—one to protect abortion until viability and another to ban abortion after the first trimester. Arguments focused on whether the protective amendment violates a state rule requiring ballot measures to only cover a single subject, according to the Nebraska Examiner.

Last month in Arkansas, the state Supreme Court threw out thousands of signatures in favor of an abortion-rights measure, ruling that organizers had failed to file training certifications for their paid canvassers in the proper format, the Associated Press reported. The decision affirmed state officials’ move to disqualify the measure from the ballot.

In Florida, the state Attorney General lost a lawsuit arguing that an amendment to protect abortion rights until viability was “too complicated” for voters to understand. But last month, the state Supreme Court approved a fiscal impact statement for Amendment 4 written with the help of the Heritage Foundation, the conservative group behind Project 2025. Meanwhile, the state’s Agency for Health Care Administration unveiled a website on Thursday full of false claims about the initiative, as my colleague Julianne McShane reported. And the Florida Department of State is reportedly investigating 36,000 voter signatures submitted by amendment organizers.

As it stands on Tuesday, ten states will vote on abortion-related measures on the ballot come November. Missouri is one of two where voters could overturn a near-total abortion ban.

Sophie Hurwitz contributed reporting.