A Missouri judge restored broad access to medication abortion Thursday, striking down numerous restrictive state laws that conflicted with a 2024 voter-approved constitutional amendment protecting reproductive rights in the state. The ruling, issued by Judge Jerri Zhang of Jackson County Circuit Court, comes after years of contentious legal battles following the Supreme Court’s 2022 decision overturning federal abortion protections in Dobbs v. Jackson Women’s Health Organization.

The amendment approved by Missouri voters last year guarantees a “fundamental right to reproductive freedom,” effectively overturning a near-total abortion ban enacted shortly after the Dobbs ruling. However, the state’s Republican-controlled Legislature had passed numerous laws over the years regulating abortion providers through strict licensing requirements, wait times, insurance mandates, telemedicine restrictions, and other measures. Those laws, Planned Parenthood and the American Civil Liberties Union of Missouri argued, made it virtually impossible to access abortion care, including medication abortions, despite the constitutional amendment.

In her decision, Judge Zhang found that approximately 40 state laws challenged by abortion rights organizations were incompatible with the 2024 ballot initiative. The ruling permits physicians to resume providing medication abortions, a method involving a two-pill regimen of mifepristone and misoprostol used in most early-term abortions. Zhang maintained some restrictions, including that abortions must be performed by licensed physicians and require at least one in-person patient examination.

Missouri Attorney General Catherine Hanaway condemned the ruling as “radical” and accused it of granting abortion providers a “free pass” to self-regulate. She pledged to appeal the decision promptly to the Missouri Supreme Court. The state’s highest court previously blocked abortion access by ruling that Judge Zhang had not met the legal standards necessary to override certain statutes.

Planned Parenthood Great Plains President and CEO Emily Wales welcomed the ruling, emphasizing that it restores “compassion and common sense” to health care in Missouri. The ACLU of Missouri’s director of litigation, Gillian Wilcox, called the decision a “monumental win” amid ongoing political efforts to undermine reproductive freedoms. She highlighted a measure set to appear on the November ballot that would seek to repeal the 2024 amendment.

The ruling follows a 10-day bench trial held earlier this year, during which Judge Zhang heard testimony from health care providers, insurance experts, government officials, and individuals who shared personal abortion experiences. The trial underscored the impact of decades of regulatory hurdles imposed by lawmakers on patients seeking abortion care.

The controversy has centered largely on medication abortion, which became a focal point following the FDA’s 2021 authorization of telemedicine prescribing and mail delivery of abortion pills during the COVID-19 pandemic. Since the Dobbs decision, numerous states have targeted medication abortion in efforts to restrict access, making Missouri a key battleground in the broader national abortion debate.

With the legal conflict far from over, the state’s abortion providers are poised to resume medication abortions in Missouri for the first time in nearly a decade pending the outcome of forthcoming appeals.