Missouri

February 19, 2024 Update

Efforts are underway to place abortion-related ballot measures to amend the state constitution in Missouri to establish a right to abortion up to 12 weeks, to protect the pregnant individual in life-threatening situations, and in cases of fatal fetal anomalies, rape, and incest (approved for circulation); protecting reproductive freedom (currently gathering signatures)

August 17, 2023 Update

In July, two days after hearing arguments on the matter, the state Supreme Court rejected a push by the Attorney General to inflate the cost of an abortion-rights amendment. The fiscal note at the heart of the case was developed as a matter of procedural routine after 11 versions of a proposed constitutional amendment rolling back Missouri’s abortion ban were filed with the secretary of state’s office.

March 2023 Report

A ban has been enacted on in-state abortion care. The import of these bans for the practice of reproductive medicine and, specifically, the use of Assisted Reproductive Technology (ART) to build families, varies on a state-by-state level. While the majority of states’ abortion ban statutes are applicable in the context of a pregnancy, many state laws also include definitions stating that “personhood” begins at fertilization or even conception. Such definitions -- whether intentionally or not -- have the potential to implicate and even ban the use of ART, including in vitro fertilization (IVF), though some states have taken steps to carve this out as allowable. In a growing number of states, statutory restrictions severely limit access to abortion care and implicitly threaten the unhindered practice of reproductive medicine.

Taxes, religious freedom, and additional out-of-the-box proposals

Abortion choice proponents Missouri have challenged the states’ laws on grounds that they violate individuals’ religious freedom. Anti-abortion advocates, in response, also hold up religious freedom as a plausible defense to being required to perform or otherwise facilitate the procedure. The rulings in these cases, all of which remain outstanding at time of publication, will set important precedent.

States’ tax codes are also positioned for potential makeovers as the debate on abortion access rages. Missouri has long had a measure on its books offering new tax credits to incentivize private donations to private pregnancy centers, which, by definition, do not offer abortion care and, some maintain, mislead patients.

October 2022 Report

Summary of Current (and Most Recent) Abortion and Personhood Laws

Missouri law currently prohibits abortion except in cases of a “medical emergency.” Mo. Rev. Stat. § 188.017.
Missouri has not amended its abortion statute since the Dobbs decision; however, the Missouri Attorney General issued an opinion letter on June 24, 2022, which “triggered” the total prohibition on abortion noted above. 22 Op. Att’y. Gen. 2022 (2022) (providing notification that Roe was overturned and putting into effect Section 188.017).

Potential impact of the law on and references to IVF and reproductive medicine if any

It does not appear that current abortion restrictions in Missouri will apply to IVF or other reproductive medicine services outside the context of a pregnancy.
There are no explicit references to IVF or reproductive medicine services in the state’s abortion statutes.
The statutes defining “abortion” refer to “an embryo or fetus in its mother’s womb” and “the “intentional termination of the pregnancy.”

Relevant definitions

“Abortion” is defined as “[t]he act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of the embryo or fetus in his or her mother’s womb” or “[t]he intentional termination of the pregnancy of a mother by using or prescribing any instrument, device, medicine, drug, or other means with an intention other than to increase the probability of a live birth or to remove a dead unborn child.” Mo. Rev. Stat. § 188.015 (1).
“Conception” is defined as “the fertilization of the ovum of a female by sperm of a male.” Mo. Rev. Stat. § 188.015 (3).
An “unborn child” is defined as “the offspring of human beings from the moment of conception until birth and at every stage of its biological development, including the human conceptus, zygote, morula, blastocyst, embryo, and fetus.” Mo. Rev. Stat. § 188.015 (10).
A separate part of the code states that “[t]he life of each human being begins at conception.” Mo. Rev. Stat. § 1.205 (1).
The section further defines the terms “unborn child” and “unborn children” to “include all unborn child or children or the offspring of human beings from the moment of conception until birth at every stage of biological development.” Mo. Rev. Stat. § 1.205 (3).

Penalties for violations of the applicable abortion restrictions

“Any person who knowingly performs or induces an abortion” may be subject to criminal and civil penalties, and a licensed provider may be “subject to suspension or revocation of his or her professional license by his or her professional licensing board.” Mo. Rev. Stat. §§ 188.017 (2), 188.058 (1), 188.375(3).

June 2022 Report

Trigger Law Statutory Cite(s)

Right to Life of the Unborn Child Act, Mo. Ann. Stat. §§ 188.015, 188.017.

Does this law have a potential impact on IVF/Reproductive medicine?

Why or why not?

Seemingly no impact on IVF or other ART procedures.
The statute does not appear to be applicable to IVF and reproductive medicine services prior to implantation of embryos.
The first sub-section defines abortion as the act of prescribing or using any means with the intent of destroying the life of an embryo or fetus in its mother’s womb.
The second section of the definition explicitly defines abortion as the “intentional termination of the pregnancy of a mother… with an intention other than to increase the probability of a live birth or to remove a dead unborn child.”
An unborn child is defined to include everything the moment of conception including a zygote, morula, blastocyst, embryo, and fetus, but this term is used in the context of abortion.

Does this law explicitly reference IVF, assisted reproductive technology or reproductive medicine?

There are no explicit references to IVF or reproductive medicine services.

Are there any penalties in this law that could apply to ART procedures?

The law does not appear to be applicable to ART procedures.

Relevant definitions

“Abortion” is defined as “[t]he act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of the embryo or fetus in his or her mother’s womb” or “[t]he intentional termination of the pregnancy of a mother by using or prescribing any instrument, device medicine, drug, or other means with an intention other than to increase the probability of a live birth or to remove a dead unborn child.”
“Conception” is defined as “the fertilization of the ovum of a female by sperm of a male.”
An “unborn child” is defined as “the offspring of human beings from the moment of conception until birth and at every stage of its biological development, including the human conceptus, zygote, morula, blastocyst, embryo, and fetus.”
A “medical emergency” is defined as “a condition which, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert the death of the pregnant woman or for which delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”
“Reasonable medical judgment” is defined as “a medical judgment that would be made by a reasonably prudent physician, knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.”
However, a separate part of the code states that “[t]he life of each human being begins at conception” (Mo. Rev. Stat. § 1.205).
The section further defines the terms “unborn child” and “unborn children” to “include all unborn child or children or the offspring of human beings from the moment of conception until birth at every stage of biological development.”

Do the definitions/terms of the trigger law apply to other areas of state code?

The definitions apply throughout the chapter of Missouri law entitled “Regulation of Abortions”.

What is the “trigger” for this law to take effect?

The trigger law will become effective if one of three actions occurs:

The Attorney General of Missouri notifies the revisor of statutes that the Supreme Court has overruled Roe and that it is “reasonably probable” that the section would be upheld as constitutional or by way of constitutional amendment or Congressional action the state’s authority to regulate abortion in accordance with the trigger law has been restored or granted.
Alternatively, the law can become effective if either the Governor of Missouri issues a proclamation, or
The Missouri General Assembly adopts a concurrent resolution recognizing that the authority to regulate abortion in accordance with the trigger law has been restored either by the Supreme Court, constitutional amendment, or Congressional action.

Key provisions: What does the law prohibit and when does it apply?

The law provides that “no abortion shall be performed or induced upon a woman, except in cases of medical emergency.”
The Act explicitly shields women who undergo abortions in violation of the law from liability for conspiracy: “[a] woman upon whom an abortion is performed or induced in violation of this subsection shall not be prosecuted for a conspiracy to violate the provisions of this subsection.”

State Legislation and Reproductive Medicine

The ASRM Center for Policy and Leadership (CPL) has released reports concerning States' Abortion Laws and their Potential Implications for Reproductive Medicine. Current as of the date of publication, the reports provide an overview of states’ abortion laws, together with analysis of potential implications for reproductive medicine, including IVF.