Doctor: Rising number of medication abortions underscores need for passage of Amendment 3

A judge’s decision last summer to wipe out a broad swath of Missouri’s abortion regulations has left women seeking medication abortions with fewer safeguards, according to a St. Louis physician.

That’s why passing Amendment 3 to the Missouri Constitution is critical to restoring basic protections, including clinic inspections, physician responsibility and the ability to hold providers accountable when complications happen, said Dr. David Stansfield, a retired family medicine physician and president of the Catholic Medical Association’s St. Louis Guild.

A rise in medication abortions, often obtained through telemedicine or online without medical oversight, poses serious risks to women, Stansfield said.

Recent data from the Guttmacher Institute shows that the number of Missourians receiving abortion pills by mail from out-of-state providers has quadrupled since 2023, according to a report from the Missouri Independent.

Dr. Stansfield pointed to a 2025 analysis by the Ethics and Public Policy Center that looked at an insurance claims database of 865,727 mifepristone abortions between 2017 and 2023 and found that 10.93% of women experienced serious adverse events — including sepsis, infection, hemorrhage or incomplete abortion — within 45 days.

Those numbers are troubling as more women obtain abortion pills through telemedicine or online, often without an in-person exam or ultrasound to confirm gestational age or rule out an ectopic pregnancy, he said.

“You cannot do an ultrasound over the phone,” Dr. Stansfield said. “And without the ultrasound, you don’t know for sure the gestational age, and you don’t know whether it’s a tubal (ectopic) pregnancy or not. That’s enormous — you’ve got to know that.”

Amendment 3 represents a necessary, incremental step toward more ethical and medically responsible abortion regulation, Stansfield said.

If passed by Missouri voters on Nov. 3, the measure would limit most abortions except for cases of rape and incest (up to 12 weeks of gestation), emergencies and fetal anomalies.

It would also repeal a 2024 voter-approved amendment, which allows for abortions through fetal viability but also offers a broad exception for the “life and physical or mental health of the pregnant person.”

The proposed amendment would allow the legislature to reinstate health and safety inspections at abortion facilities; require parental consent for minors receiving medical procedures; require physicians performing abortions to have nearby hospital admitting privileges; ensure access to care for medical emergencies, ectopic pregnancies and miscarriages; provide medical malpractice protections; and constitutionally prohibit gender transition surgeries and prescribing medications for gender transition, including puberty blockers, for minors younger than 18.

While Dr. Stansfield said he opposes abortion as a matter of faith and medical ethics, he said the amendment would impose common-sense safeguards: restricting abortions to earlier gestational ages, where complication rates are lower, holding clinics to the same standards as other surgical centers, restoring the legislature’s ability to enact safety regulations and clarifying that physicians must be responsible for patients when complications arise.

“As Catholics and as Christians living in the United States — we are the government,” he said. “It’s we the people. As a citizen of the United States, my vote matters greatly in heaven, and what our government does reflects me as far as our Lord is concerned.”

Apart from religion, Dr. Stansfield added that the government also maintains an interest in keeping abortion rare and supporting population growth.

The push for new legislation follows a Jackson County Circuit Court ruling in June, when Judge Jerri Zhang issued a permanent injunction striking down several state abortion laws that were challenged under the 2024 constitutional amendment.

Among those provisions were special licensing requirements for abortion providers, an admitting-privileges requirement and the state’s requirement that a physician to be physically present when a patient takes abortion medication.

Both medication and surgical abortions have resumed in Missouri since the ruling. However, Judge Zhang left in place a requirement that patients meet with a doctor in person before being prescribed abortion medication and that only licensed physicians can prescribe or perform abortions.

Missouri’s ban on in-state providers prescribing abortion medication via telehealth also remains in place, meaning those who wish to access abortion pills without an in-person visit must seek an out-of-state provider.

Missouri Attorney General Catherine Hanaway has appealed the ruling to the Missouri Supreme Court.

Supporters of Amendment 3 say that its passage would allow legislators to restore the safety regulations. Dr. Stansfield described the measure as an incremental approach that holds abortion facilities to “the very same requirements of any other surgical center in Missouri” while ensuring that women have the ability to sue for malpractice if they are injured.

Under the current framework, Dr. Stansfield questioned the lack of oversight.

“How is that a service to the women of St. Louis or Missouri ... that nobody can inspect the cleanliness and sterility of the place or the equipment?” he said. “How does that protect a woman? It protects Planned Parenthood, but it does not protect society.”

For additional information and resources on Amendment 3, visit diojeffcity.org/amendment3

Jennifer Brinker is a reporter for the St. Louis Review and Catholic St. Louis, official publications of the St. Louis archdiocese (stlouisreview.com). This article is reprinted here with permission.