Missouri voters reject ballot measure seeking to add trans youth care restrictions to constitution
TOPSHOT – This aerial view shows Union Station illuminated with the colors of the US flag after the midterm elections in Kansas City, Missouri, in the early hours of November 4, 2026. (Photo by Austin (Getty Images)
Missouri voters have rejected Amendment 3, blocking an attempt to write restrictions on gender-affirming care for trans minors into the state constitution.
The ballot measure would also have repealed Missouri’s 2024 voter-approved abortion-rights amendment, pairing an abortion rollback with a constitutional clampdown on transgender healthcare.
Amendment 3 failed after receiving only 44 per cent support. The Associated Press called the measure’s defeat on Tuesday, with opposition exceeding 55 per cent of the vote.
What was Missouri Amendment 3?
Amendment 3 was designed to do two things at once: undo the abortion protections voters backed in 2024, and add restrictions on transgender minors’ medical care to Missouri’s constitution.
The attempt to add the restrictions to the constitution would have made them hard to undo, as constitutional language is far harder to unwind than ordinary state law. The defeat leaves Missouri’s current restrictions on gender-affirming care for minors in place, but stops them from being written into the constitution, where reversing them would have been more difficult.
Amendment 3 was put forward by Republican lawmakers, Missouri’s first lady, Claudia Kehoe, serving as treasurer for the campaign in an attempt to pass it.
Tom Estes, described as a Republican state Senate staffer working on the pro-Amendment 3 campaign, told The 19th: “There are several pieces of this that resonate really well, that we may not have gotten last time. The number one piece of that is the trans issue.”
What happens to trans healthcare now?
Missouri is a politically conservative US state where abortion and trans healthcare have been major flashpoints since the fall of Roe v. Wade. Across the US, Republican-led states have pursued restrictions on gender-affirming care for minors, often alongside broader culture-war messaging.
Missouri’s statutory ban on transition-related surgeries for minors doesn’t have an expiry date; however, limits on puberty blockers and hormone therapy are due to lapse in August 2027. The ballot measure would have meant that those restrictions were placed in the state constitution without that expiration date, and voters declined to do so.
In 2023, Missouri’s attorney general launched an online form urging residents to “submit a complaint or concern” about gender transition intervention they had “experienced or observed” in the state.
