Dr. Margaret Baum (second from left), chief medical officer for Planned Parenthood Great Rivers, stands with attorneys from the Planned Parenthood Federation of America on the steps of the Jackson County Courthouse in Kansas City, Missouri, on Jan. 12, 2026, the first day of a two-week trial over abortion restrictions. (Photo by Anna Spoerre/Missouri Independent)

The outcome of two trials in the coming weeks could shape what it will look like when voters overturn state abortion bans through future ballot initiatives.

Arizona and Missouri voters in November 2024 struck down their respective near-total abortion bans. Both states added abortion access up to fetal viability as a right in their constitutions, although Arizonans approved the amendment by a much wider margin than Missouri voters.

That was just the beginning of protracted legal battles.

Amy Myrick, senior counsel at the Center for Reproductive Rights, said ballot measures are a powerful and important step in returning abortion access to a state, but success on Election Day doesn’t mean the fight is over.

“State constitutions don’t automatically repeal laws,” Myrick said. “Sometimes, even if the state isn’t doing it, other groups or legislators will jump in to try to retain these restrictions.” 

The trial over Arizona’s abortion restrictions wrapped up this week, Arizona Mirror reported. Maricopa County Superior Court Judge Gregory Como seemed unconvinced of the argument that certain laws around how abortion medication can be prescribed, waiting periods and bans on abortions in cases of fetal abnormalities should remain enforceable.

A similar trial in Missouri will wrap up on Jan. 26 after hours of testimony about more than a dozen abortion restrictions state officials are seeking to preserve. The Republican supermajority state legislature is also putting a countermeasure to reinstate the abortion ban on the ballot in November, paired with a ban on gender-affirming care for minors. 

Arizona and Missouri have what are known by abortion-rights advocates as Targeted Regulation of Abortion Providers, or TRAP, laws passed by legislatures before the U.S. Supreme Court’s Dobbs decision in 2022. Even states without bans, like Connecticut, Maryland and Rhode Island, have statutes in place that the Guttmacher Institute considers TRAP laws. Abortion providers are subject to state licensing and other medical requirements, but as of December, 25 states still have laws that impose additional regulations for clinics, according to Guttmacher, such as facility size and transfer agreement requirements, or admitting privileges at local hospitals within 30 miles.

Officials and legislators usually argue in the statehouse and in court that the extra parameters increase the safety of abortion procedures, but the safety record is strong under existing medical requirements and is safer than childbirth, according to the American College of Obstetricians and Gynecologists. Studies show the risk of maternal death associated with childbirth is about 14 times higher than the risk associated with abortion.

But there are also other laws that advocates say are meant to discourage or frustrate those seeking abortion care, such as mandatory vaginal exams, waiting periods, or a requirement that the same physician must see an abortion medication patient over two subsequent visits. Some of those laws were passed over decades and helped drive abortion providers away, including in Missouri.

As a result, even though Missourians overturned the ban, abortion care remains difficult to obtain, and many are still leaving the state to get it, according to Missouri Independent.

“Because constitutional amendments don’t overturn conflicting laws, people can still experience injuries under these laws,” said Prachi Dave, senior managing legal and policy director at If/When/How, a reproductive rights legal services and advocacy organization. “For example, if a waiting period is interfering with my ability to access the care I am guaranteed under the newly passed amendment, then I would ask a judge to affirm that the law is getting in the way of my right. In doing so, lawsuits give practical effect to constitutional amendments.”

In a Michigan lawsuit led by advocacy groups, a judge ruled in May that a mandatory waiting period was unconstitutional after voters approved an initiative codifying reproductive rights.  

Wendy Heipt, attorney for advocacy organization Legal Voice in Washington, said even if some laws were ruled unconstitutional, they may have to be litigated again because the basis for the unconstitutional argument relied on the Roe v. Wade case that the U.S. Supreme Court overturned almost four years ago.

Heipt frequently works on cases in Idaho, where many lawsuits over the state’s near-total abortion ban have taken place in the past three years. Though still in effect, there is an effort to overturn the ban via ballot in November. 

The initiative is different from those approved in Arizona and Missouri because people in Idaho cannot submit constitutional amendments — only proposed state laws — for ballot consideration directly.

Melanie Folwell, lead organizer of the reproductive rights initiative in Idaho, said even if successful, it’s only one leg of a long race in restoring access. The initiative group, Idahoans United for Women and Families, drafted a bill that would have repealed existing abortion laws, but it was too long and legally complicated for the ballot. Instead, what they’ve come up with for voters is meant to establish a right to reproductive health privacy without undue government interference and override existing laws. 

The outcome of Missouri’s trial could be instructive for Idaho abortion-rights advocates, because the political environments are similar. Idaho has a lengthy list of its own waiting periods for abortion care, mandatory counseling and ultrasound requirements, and elected officials in the Republican-led state have repeatedly signaled their opposition to abortion access, including the attorney general. The legislature also has a Republican supermajority.

And since it can’t be a constitutional amendment, any new law may be more vulnerable to legal challenges. 

“There are things to learn from every one of the states that have reproductive access on the ballot, which is 17 states at this point,” Folwell said. “It is always instructive for us to see what plays out in that state’s legislature, what plays out with their courts.”

Myrick said the legal battles can feel discouraging, but voters shouldn’t let it stop them from using their voices to make their policy preferences known.

“Ballot measures are not the silver bullet. We need a lot of follow-up to make these rights real. And the attempts to keep these restrictions after the voters have spoken are blatantly anti-democratic, but they’re still happening,” Myrick said.