Executive Summary: The Geographic Shift
Data from 2018 through 2023 shows a clear pattern following the **June 2022 law** that restricted induced termination of pregnancy in Missouri. The primary finding is that the law created a major **geographic shift** in where procedures were obtained, but it had only a minimal effect on the state's overall birth rate.
Key Data Points:
- **In-State Procedures Decreased:** Procedures performed inside Missouri dropped from 1,471 in 2019 to just 37 in 2023.
- **Resident Procedures Increased:** The estimated total number of procedures obtained by Missouri residents (mostly by traveling out of state) grew from about 3,653 in 2021 to an estimated 11,600 in 2023.
- **Births Barely Changed:** Despite the procedure restrictions, Missouri's resident live birth rate only experienced a 0.4% increase, which was the smallest increase among all studied states with similar restrictions.
Understanding the Data: In-State vs. Resident Procedures
To understand the real impact of the law, it is necessary to look at two different metrics:
- **Missouri In-State Occurrence:** Counts procedures performed **within Missouri’s borders**. This number is now minimal.
- **Estimated Total Resident Procedures:** Captures all procedures obtained by Missouri residents, regardless of where they happen (in-state, in other states, or through non-clinical methods like **mail-order medication**).
Official state-to-state reporting is incomplete. For example, while Missouri officially reported 3,029 resident procedures in 2023, independent external estimates put the total at **11,600**. This large difference confirms that many procedures—especially those obtained in neighboring states or through telehealth—are not fully tracked by official state data.
Longitudinal Trends and Baseline (2019–2023)
Even before 2022, Missouri's live birth rate was declining, consistent with national trends. Furthermore, pre-existing state policies had already made in-state procedures rare. This meant that Missouri residents were already utilizing external options before the 2022 trigger law.
| Year | MO Resident Live Births (A) | MO In-State Occurrence (B) | Estimated Total Resident Procedures (C) |
|---|---|---|---|
| 2019 | (Data Varies) | 1,471 | 4,333 |
| 2021 | (Data Varies) | 150 | 3,653 |
| 2022 | 68,954 | 88 | 10,255 |
| 2023 | 67,123 | 37 | 11,600 |
The Minimal Impact on Live Births
The most important finding is the effect (or lack thereof) on live births. The provisional count of resident live births in 2023 was 67,123, the lowest since 1945. Academic studies confirm that the restriction resulted in only a **0.4% increase in the birth rate** attributable to the new law.
Why was the impact so low?
This small increase (compared to a 2.3% average in other states with bans) is mainly due to the **External Resource Utilization**. The established flow of Missouri residents traveling out of state, combined with the rise of non-clinical access like telehealth/mail-order medication, largely absorbed the demand that was eliminated from in-state clinics.
The **Estimated Resident Procedure Ratio** (procedures per 1,000 live births) confirms this sustained demand: it jumped from 148.7 in 2022 to 172.8 in 2023, showing that residents continued to access procedures at a high rate.
Policy Implications for Amendment 3
Based on this data, the implementation of a future constitutional measure like Amendment 3 (HJR 73) is likely to have a **minimal effect on the total number of live births** for several reasons:
- **The Precedent is Set:** The prior law resulted in only a 0.4% birth rate increase, showing that external access is already negating policy effects.
- **External System Exists:** A robust system of out-of-state facilities and telehealth services is already successfully meeting resident demand (11,600 procedures in 2023).
- **Method is Unaffected:** Methods like mail-order medication are not reliant on in-state facility visits and operate outside Missouri's direct regulatory control.
Conclusion: The data suggests that Amendment 3 would primarily **formalize the existing situation** where procedures are obtained outside of the state, rather than substantially reducing the overall number of procedures accessed by Missouri residents.