Missouri voters rejected Amendment 3 on Tuesday, Nov. 3, according to an Associated Press race call reported by NPR. The defeat preserves the abortion-rights amendment voters approved in 2024. It also blocks a proposed constitutional ban on gender-affirming medical care for minors.
The vote does not repeal Missouri’s existing restrictions on care for transgender youth. The state’s 2023 SAFE Act still prohibits gender transition surgery for anyone under 18. It also bars most minors from starting puberty blockers or hormone therapy for gender transition.
The distinction matters for families. The medication restrictions are scheduled to expire Aug. 28, 2027, under current state law. The surgery ban has no expiration date. Amendment 3 would have put both restrictions into the constitution without a sunset.
NPR’s AP results display lists the call at 10:18 p.m. Central on Tuesday. Gayety’s LGBTQ+ election results hub has more coverage from election night.
What the Amendment 3 Result Means for Missouri
Missouri has now voted on two different measures called Amendment 3. In 2024, voters approved constitutional protections for reproductive freedom, including abortion through fetal viability. The 2026 proposal sought to repeal those protections and replace them with new restrictions.
A no vote leaves the 2024 amendment in place, according to the secretary of state’s official ballot explanation. It prevents the proposed constitutional restrictions from taking effect. It does not overturn separate statutes, including the SAFE Act.
The SAFE Act’s medication subsection exempts minors who were prescribed or administered the covered drugs before Aug. 28, 2023. Its 2027 expiration applies to that subsection, not the entire law. Other provisions, including the surgery prohibition, remain unless changed separately.
Lawmakers have already tried to remove the sunset. The House passed HB 2033 in February, but the official bill record shows no final passage. Its last listed action was an April 8 Senate committee vote. Tuesday’s result does not prevent lawmakers from taking up another bill.
What the Proposed Abortion and Trans Care Bans Included
Republican lawmakers put the measure on the ballot as House Joint Resolution 73. Its sponsor, Rep. Ed Lewis, R-Moberly, described it as a compromise in an October interview with St. Louis Public Radio.
“This is the middle of the road proposal that allows for some exceptions,” Lewis said.
The amendment’s full text would have allowed abortions for medical emergencies. It also permitted abortions for pregnancies resulting from rape or incest through 12 weeks’ gestation. Its fetal-anomaly exception covered conditions that would make life outside the womb impossible. It was not a general exception for every fetal diagnosis.
The proposal also would have prohibited gender transition surgeries, puberty blockers and cross-sex hormones for people under 18. It included exceptions for certain differences of sex development and treatment unrelated to gender transition.
Those restrictions had no expiration date. Sam Lee, director of Campaign Life Missouri, told St. Louis Public Radio that voters could make the bans permanent. His remarks described the choice he wanted voters to make.
“We do not want to leave the protections for children to the winds of the political change of whoever is in office in the legislature and courts,” Amanda Sanders, a spokesperson for Her Health, Her Future, told the Missouri Independent in October.
Gayety’s guide to the 2026 trans-related ballot measures explains how Missouri’s proposal fit into the wider election.
The SAFE Act Survived a Separate Court Challenge
The Missouri Supreme Court unanimously upheld the SAFE Act on Jan. 13, St. Louis Public Radio reported. Judge Kelly Broniec wrote the decision. The court found that the challenged ban “classifies only on age and medical use.”
The ruling also upheld restrictions on using state Medicaid funds for gender transition surgeries and hormones. Attorney General Catherine Hanaway welcomed the decision. The ACLU of Missouri, which represented challengers, condemned it.
“Today’s decision allows the state to continue to enforce a harmful ban that singles out transgender Missourians,” litigation director Gillian Wilcox said in a statement quoted by the station.
That January ruling and Tuesday’s ballot result concern different legal actions. Defeating Amendment 3 does not reverse the court’s decision.
How the Campaign Put Trans Youth at the Center
Many ads supporting Amendment 3 focused on transgender care without mentioning abortion, NPR reported. Her Health, Her Future framed the proposal around protecting children.
Its first TV ad opened with “It starts with drag queen story hour and ends with children under the knife,” the Missouri Independent reported.
Viewers asked KY3’s Fact Finders whether gender-affirming surgeries happened in Missouri schools. The state education department called that claim “not true.” Campaign adviser James Lawson told KY3 the ad made no claim about schools.
Jamie Reed, a former Washington University transgender center employee, campaigned for the amendment. “If we talk to people about the trans part of this amendment,” she told a Republican gathering, according to the Independent, “we can get it to pass.”
Gov. Mike Kehoe made a final statewide campaign tour Monday. KOMU 8 asked him whether combining abortion and transgender care made the question more confusing.
“They’re voting on both of those, and I think that’s what’s clear,” Kehoe said.
Why Opponents Called the Trans Provision ‘Ballot Candy’
Emily Wales of Stop the Ban used that phrase in an interview with KFVS on the eve of the election. She argued that the measure used restrictions already in state law to sell an abortion rollback.
“Gender-affirming care for minors in this state is already not accessible,” Wales said. The SAFE Act’s grandfathering provision is a legal exception to its medication ban, though that does not guarantee a provider will offer care.
Opponents also rejected Lewis’s description of the abortion provisions as a compromise. “The bottom line is overturning the will of the people is not middle of the road,” Mallory Schwarz told St. Louis Public Radio. Schwarz leads Abortion Action Missouri and served as a Stop the Ban spokesperson.
Trans Missourians and Families Did the Organizing
Before the election, Reneé Luckfield, 29, knocked on doors in St. Louis County for the LGBTQ+ advocacy group PROMO. KFF Health News followed her canvassing work.
“Honestly, it’s not something that I’m entirely comfortable with,” Luckfield, a transgender woman, said. “And it’s not fair that we have to do this work.”
Chelsea Freels, 20, received puberty blockers as a minor in Missouri. She told the Missouri Independent the campaign’s emphasis on trans youth stood out.
“It’s really telling that the Republicans have shifted a lot of their messaging about A3 away from abortion,” Freels said. “And towards demonizing children.”
Her mother, Rene Freels, described what she wanted for the next generation: “Us parents are trying to end this so that when we pass away, our kids don’t have to deal with this type of discrimination.”
Access to care remains a separate challenge. Planned Parenthood Great Rivers says Missouri minors starting hormone therapy can make appointments at its Fairview Heights, Illinois, health center. It serves patients 16 and older and requires a parent or guardian at visits for 16- and 17-year-olds.
Gayety’s report on Missouri families and the Amendment 3 campaign follows the work behind Tuesday’s vote.
Luckfield offered KFF Health News a reason to keep having those conversations: “People are more accepting than they think the people around them are.”
