Sylvie Richards | Managing Forum Editor

In the spring of last year, I collected signatures to get the Right to Reproductive Freedom Initiative on the Missouri Ballot. As my friend and I asked people in Bear’s Den (BD), “Do you want to end Missouri’s total abortion ban?” I was met with reactions that fell into three camps. First, eagerness to hear more and get involved. Second, averted eye contact, speed-walking away, or blatant laughing. Third, questions, including a number from people who did not know that Missouri had an abortion ban in the first place.

Of these reactions, it is not the laughing that angered me most, but rather the apathy. And it is not anti-abortion voters who worry me most as we approach the 2024 election in Missouri. We know anti-abortion voters are steadfast in their opposition and will vote against Amendment 3. I worry, instead, about the voters who don’t know where they stand, or who don’t care. The reproductive healthcare crisis requires immediate action, not indifference. This November, registered voters in Missouri have a chance to take decisive action by voting yes on Amendment 3.

In today’s political climate, most people understand at least some of the impacts of abortion bans, regardless of where they stand on the issue. Still, in discussions among many young people, abortion is often treated as an abstract and distant concept. It is hard for people across the board to understand the scope and severity of the impacts of these bans. So as we approach the election in November, we need to establish how high the stakes really are.

In the 2022 case Dobbs v. Jackson Women’s Health Organization, the U.S. Supreme Court overruled the constitutional right to abortion and returned the power to regulate abortion to the states. Missouri became the first state to ban abortion after Dobbs on June 24, 2024, banning all abortions except in cases of a medical emergency. Abortion bans have since spread across the country, with 21 states passing abortion bans that would have been considered unconstitutional pre-Dobbs and 13 states passing total abortion bans. 

At the same time, state courts have legally challenged abortion bans, and abortion-related measures have put the question of abortion rights on state ballots. In 2022, abortion access was put to a vote in seven states. Each of the efforts ended in favor of the right to abortion, with four states amending the constitution to include the right to reproductive freedom. This year, 10 states, including Missouri, will have reproductive rights on the ballot.

As college students, we need to understand and talk about how abortion bans affect us and our close communities. As human beings, we need to understand, discuss, and feel outraged about abortion bans for what they are — a public-health crisis. These bans are causing and exacerbating extreme harm, poverty, and sometimes death for people in Missouri and across the country. 

Missouri voters will have the chance to enshrine the right to reproductive freedom in the state Constitution by voting yes on Amendment 3, the Right to Reproductive Freedom Initiative. This amendment declares that “The Government shall not deny or infringe upon a person’s fundamental right to reproductive freedom,” which includes “all matters relating to reproductive healthcare.”

As you consider your vote on Amendment 3, it is important that you understand the detrimental impacts of Missouri’s abortion ban. 

It may not seem like the abortion ban will impact you or people close to you. Yet, abortion is an exceptionally common procedure. One in four women will have one in their lifetime. The majority of people (61%) who receive this care are in their 20s and the vast majority (95%) of abortions are results of unintended pregnancies. You may not think you know someone who has had an abortion, but you probably do.

“There are people who are — through no fault of their own, through no decision-making of their own — still suffering immensely under this ban,” senior Maddy Molyneux, president of WashU’s chapter of Planned Parenthood Generation Action (PPGA), told me in an interview. “It could be you, it could be a friend, it could be a teacher, it could be anyone.” Molyneux added that under the current ban, there are no exceptions for rape and incest.

A year after Dobbs, a KFF study found that over half of women between the ages of 18 and 49 reported that “they or someone they know has taken at least one of several steps aimed at reducing the likelihood of getting pregnant due to concerns about not being able to access an abortion.” This includes 28% of women who bought emergency contraception in case of needing it in the future. 

WashU students are no exception. PPGA offers free Plan B for students, which Molyneux said has been very important and successful since Dobbs. Molyneux explained, “I think there’s a certain level of fear [that an abortion ban] instills in young people. And I think that’s probably why we’ve seen the demand that we’ve seen for contraceptives and emergency contraceptives recently.” 

This fear is far from unfounded or irrational. Being pregnant in Missouri and other states with abortion bans has severe health risks, and the quality of care that patients receive has decreased due to bans’ restrictions on healthcare providers. While every abortion ban in the U.S. provides exceptions for emergencies, the definition of “emergency” is so vague that doctors face hurdles to helping their patients in medical crises. 

Doctors throughout the country have reported having to wait for their patients to be on the brink of death before taking action due to abortion restrictions. In September, Amber Nicole Thurman got a rare infection after taking the abortion pills mifepristone and misoprostol. The 28-year-old was from Georgia, where there is a six-week abortion ban and where doctors can face up to a decade in prison for providing abortion care. When she went to the hospital, the doctors, instead of providing the common medical solution of a dilation and curettage (D&C) abortion, waited 20 hours to operate. Within those hours, Thurman’s infection spread and her organs failed. She died before they could perform the procedure. Thurman’s story is one of many in which people face preventable death or severe medical harm due to abortion bans in their state, including in Missouri.

“Women and physicians don’t know where the line is and what constitutes a medical emergency because it’s not defined,” Dr. Jennifer Smith, an OB/GYN at Barnes-Jewish Hospital and president of Missouri Healthcare Professionals for Reproductive Rights, told me in an interview. “Women are afraid that if they have a complication, they won’t be able to get care in Missouri. And frankly, most of the time, they probably can’t.” She explained that whether doctors will delay abortion-related care depends largely on what hospital you go to.

Beyond the care that doctors can provide, the abortion ban has also restricted what medical students and residents can learn about. Since the ban, medical students and residents have faced barriers to comprehensive family-planning education. I talked to Pamela Merritt, the executive director of Medical Students for Choice (MSFC), an international nonprofit organization that advocates for access to reproductive-healthcare education. Merritt described the impact of abortion bans on medical students and residents as “catastrophic.” 

Merritt explained that at many medical schools currently, abortion is no longer discussed or included in classwork. “Across the board, what we’re seeing is that abortion and family-planning has been removed from the academic setting, which is not necessary. But most of the institutions have erred on the side of extreme caution,” she said.

While residents at the WashU School of Medicine can access education and training at nearby clinics in Illinois, Merritt noted that residents at the University of Missouri must travel three hours to get to the nearest abortion clinic. Any training that they receive there will not be salaried, nor will Missouri pay for their transportation or housing to receive such training.

“That now makes that access about money,” Merritt said. High-income students will be able to get this training, while low-income and first-generation medical students will not. Merritt explained that clinic experience is “directly connected to whether people can see themselves as a provider in the future.” Ultimately, these barriers to education could decrease the number and diversity of OB/GYNs in the future.

These changes have potential impacts on doctor training in states with bans; the year after Dobbs, there was an 11.7% decrease in applications to OB/GYN residency programs in states with abortion bans, compared to a 5.3% decrease to programs in states where abortion remains legal.

The total abortion ban in Missouri should deeply concern you. Your community, including at WashU and in Missouri, is suffering under this ban — especially low-income and rural people, and people of color. It is far harder for these communities to access care, as many live hours away from abortion clinics, do not have the ability to take time off of work, or cannot afford childcare and lodging. Additionally, continuing a pregnancy is a far greater health risk than getting an abortion, and these dangers disproportionately impact women of color. 

People forced to carry out pregnancies must face the threat of extremely high maternal mortality rates, which are 62% higher in states with highly restrictive abortion bans. Black women are three times more likely to die by carrying out a pregnancy than white women. After people are forced to continue their pregnancy and have a child, they are also more likely to experience household poverty, raise the child alone, stay in contact with a violent partner, and face life-threatening as well as non-life-threatening health consequences.

Abortion access will not stop being a problem regardless of November’s election results, as there will likely be a long process of litigation to reestablish this care. However, if Amendment 3 passes, reproductive freedom will be guaranteed under Missouri’s constitution. This acknowledgment establishes that every Missourian has a right to make their own reproductive-healthcare decisions. 

We, as college students, must use this leverage to further advocate for reproductive justice, including access to abortion, contraception, and safe environments to be pregnant and raise children in. We must acknowledge the widespread impacts of abortion bans, including how they affect each and every one of us — and also who they impact most. 

We cannot be apathetic. We should acknowledge reproductive healthcare for what it is — a fundamental right.