Disputes over viability are dividing abortion-rights groups and complicating ballot measure efforts

JEFFERSON CITY, Mo. (AP) — Reproductive rights activists in Missouri agree they want to get a ballot measure before voters this fall to roll back one of the strictest abortion bans in the country and ensure access. The sticking point is how far they should go.

The groups have been at odds over whether to include a provision that would allow the state to regulate abortions after the fetus is viable, a concession supporters of the language say will be needed to persuade voters in the conservative state.

It’s a divide that’s not limited to Missouri.

Advocates say the disagreements there and in other states where activists are planning abortion-rights measures this year have resurfaced long-brewing ruptures among reproductive rights advocates. The divisions are most acute in Republican-leaning or closely divided states, where some worry that failing to include limits related to viability will sink the measures.

The conflict has been especially sharp in Missouri, where dueling strategies have complicated efforts to push ahead with a ballot measure seeking to reinstate the right to abortion.

“The movement is grappling with its value system,” said Bonyen Lee-Gilmore, the Kansas City-based vice president of communications for the National Institute for Reproductive Health, which opposes viability clauses.

Viability is generally used to refer to the phase, typically around 23 or 24 weeks into pregnancy, when a fetus would be able to survive outside the uterus. But medical experts say it creates an arbitrary dividing line and stigmatizes abortions later in pregnancy, which are exceedingly rare and usually the result of serious complications, such as fetal anomalies, that put the life of the woman or fetus at risk.

Pamela Merritt, executive director of Medical Students for Choice, which opposes viability clauses, calls it “a social construct, an arbitrary line in the sand. It’s not a medical term, and we need to back away from perpetuating these damaging terms that are a legacy of Roe that we don’t need to resurrect.”

The Supreme Court’s 1973 Roe v. Wade decision established a constitutional right to abortion but also created a framework that allowed states to regulate abortions at certain points during pregnancy. Since the current court overturned it in 2022, “Roe is the floor, not the ceiling” became a rallying cry for activists who vowed to rebuild access, especially for marginalized communities, Merritt said.

Yet measures proposed for this year’s ballot in Missouri, Florida and Arizona have been replicating Roe’s viability framework, as did an Ohio constitutional amendment guaranteeing the right to abortion that passed last year.

In Oklahoma, viability has been central to conversations about a potential ballot measure to repeal the state’s abortion ban, said Rebecca Tong, co-executive director of Trust Women, which provides abortion care and advocates for reproductive rights. Tong said viability is “not something we want written into the Constitution in Oklahoma.”

Missouri has found itself in the center of the national debate over viability as abortion-rights groups have split over which of 11 versions of a measure to support for the ballot. Some allow bans on abortion after viability.

The petitions have been tied up in court for months after being challenged by Republican Secretary of State Jay Ashcroft.

Complicating the effort is another initiative petition — one proposed by a Republican, strategist Jamie Corley. It would allow abortions up to 12 weeks into pregnancy and include exceptions for rape, incest or to protect the life of the mother until viability.

Corley said those restrictions are what’s feasible to pass in Missouri, where Republicans banned abortions except in medical emergencies.

“Pro-life, anti-abortion voters, a lot of them are still OK with legal but limited access,” Corley said. “They’re not going to vote for codifying Roe, but they are OK with 12 weeks. And they’re certainly OK with it when the alternative is keeping a ban on the books with no rape and incest exceptions.”

Some reproductive rights groups advocating for versions of a more permissive ballot measure with a viability clause raised concerns that anti-abortion forces would attack proposals without one by saying it was an attempt to legalize abortion “up until birth” or “abortion on demand,” terms considered misleading by medical experts.

Sarah Standiford, national campaigns director of Planned Parenthood Action Fund, said states must balance having policies that include the “most meaningful access” but also “can withstand legal scrutiny and the ballot qualification process.”

She acknowledged that such an approach “may ultimately advance a policy that is far short of the ideal.”

Other activists say they’re increasingly frustrated by compromises they see as based on fear and repeating past mistakes in Roe v. Wade that prevented abortion access for the most vulnerable, including people with higher-risk pregnancies, people with low incomes, people of color and people living in rural communities.

They also worry the vague term viability could be manipulated by anti-abortion forces to further limit abortion rights.

“It is a restriction under the guise of reproductive freedom,” said Jennifer Villavicencio, senior director of public affairs and advocacy at the Society of Family Planning.

“Compromise never cuts in the favor of the marginalized,” she added.

In Missouri, it’s yet to be seen how and if activists divided over viability will come together. To many, there’s a sense of urgency to restore at least some rights.

“Real lives are on the line, and that has to be part of these political considerations,” said Mallory Schwarz, executive director of Abortion Action Missouri. “We have to consider both what is politically possible and also look at why that is possible in that moment.”