Case: Comprehensive Health v. Missouri

This lawsuit is about a challenge to a series of abortion restrictions in Missouri. 

On November 5, 2024, the people of Missouri voted to pass a constitutional amendment, known as the Right to Reproductive Freedom Initiative. Amongst its provisions, the amendment legalized abortion in the state until fetal viability. The amendment was codified as Art. I, § 36.2. 

The day after the amendment passed, Comprehensive Health of Planned Parenthood Great Plains and Planned Parenthood Great Rivers-Missouri (collectively, “Planned Parenthood”) filed a lawsuit in the Circuit Court of Jackson County, Missouri challenging numerous laws and regulations and restricted and banned abortion.  Represented by the ACLU of Missouri, the ACLU,  Planned Parenthood Federation of America, and attorneys from their own organizations, Planned Parenthood sued the state of Missouri, the Governor, the Attorney General, the Department of Health and Senior Services (“DHSS”) and its Director, the Missouri Division of Professional Registration, Board of Registration for the Healing Arts and several of its members, and a Prosecuting Attorney on behalf of a defendant class of all Missouri Prosecuting Attorneys (collectively, “Missouri”). 

In its complaint, Planned Parenthood challenged the state’s total ban on abortion (the “Total Ban”), a series of gestational age bans on abortion (the “Gestational Age Bans”), and bans on abortions for certain reasons (the “Reason Ban”). In addition, Planned Parenthood challenged a series of TRAP (Targeted Restrictions on Abortion Providers) laws, including: (1) a requirement that abortion clinics be licensed as an ambulatory surgical center (“ASC”); (2) a requirement that abortion providers have clinical privileges at specified hospitals; (3) a DHHS-approved complication plan requirement for use of medication abortion, that allegedly curtailed access; (4) allegedly medically unnecessary pathology requirements; (5) reporting requirements that singled out abortion providers; (6) a requirement that abortion patients receive allegedly biased information; (7) a 72-hour waiting period and two in-person visit requirement; (8) a ban on the use of telemedicine for abortion; and (9) a ban on the provision of abortion by Advanced Practice Clinicians (“APCs”). Plaintiffs also challenged criminal penalties for abortion providers.

Planned Parenthood argued that the above restrictions and regulations violated the Missouri Constitution’s Right to Reproductive Freedom Initiative as they denied Missourians the right to make reproductive decisions or otherwise interfered with access to abortion. It sought declaratory and injunctive relief and certification of the defendant class. 

On November 18, defendants filed a motion to dismiss the defendant Prosecuting Attorney and transfer the venue, and on November 25, defendants filed a motion to dismiss Planned Parenthood’s claims.  On December 4th, the court held a hearing on the motions to dismiss and motion for preliminary injunction; that same day, Judge Jerri J. Zhang denied the November 18th motion to dismiss. A few weeks later, on December 20, the court granted in part and denied in part Planned Parenthood’s motion for preliminary injunction and denied the state defendants’ November 25th motion to dismiss. It enjoined the following statutes: the Total Ban, Gestational Age Bans, and Reasons Ban. In its reasoning, the court explained:

These statutes were directly at odds with Art. I, § 36.2.  of the state constitution and therefore presumptively invalid.
Plaintiffs were likely to succeed on the merits as State Defendants had not demonstrated that the statutes were justified by a compelling governmental interest.
There was a threat of irreparable harm because being subject to an unconstitutional statute constitutes irreparable harm.
And, the public interest was in favor of granting an injunction, as a majority of the state had voted to pass Amendment 3. 
Turning to the TRAP regulations, the court enjoined the following regulations because they denied, interfered with, delayed or otherwise restrict reproductive freedom, they did not further a compelling government interest, and/or they were not the least restrictive means of achieving that interest: the hospital relationship restrictions; the medication abortion complication plan; the pathology requirements; the abortion-specific informed consent laws; waiting period regulation; the telemedicine ban. The remaining provisions were not enjoined as the court found there may be a compelling government interest and plaintiffs had not shown the probability of success on the merits. 

On December 30, Planned Parenthood filed a motion for reconsideration, asking the court to reconsider its decision not to enjoin the abortion facility licensing requirements. The State Defendants filed a notice to enforce a settlement agreement between it and  Comprehensive Health of Planned Parenthood Great Plains on January 8, 2025. 

On February 14, 2025, the court granted plaintiffs’ motions for reconsideration, thereby enjoining the abortion facility licensing requirements, and to certify a defendant class. In the order, Judge Zhang explained that the facility licensing requirement was facially discriminatory as it treated services provided in abortion facilities differently than similarly situated health care, including miscarriage care. In addition, he held that plaintiffs had demonstrated a likelihood of success on the merits. Concerning the defendant class, Judge Zhang found that the class met the requirements of numerosity, commonality, typicality, and adequacy.  

As of March 2025, the case is ongoing, and a bench trial is set for January 12, 2026.