In November, Missouri became the first state to overturn a near-total abortion ban by a citizen-sponsored ballot measure. On Wednesday, it became the first state to try to reverse that decision through a ballot question, after the Republican-controlled legislature approved a measure that would ask voters to ban abortion again.

The question will appear on the ballot in November 2026, although Gov. Mike Kehoe, a Republican who opposes abortion rights, could choose to put the issue before voters in a special election before that.

The measure would amend the state Constitution to ban abortion except in medical emergencies, or in cases of rape or incest if the assault was reported to police within 48 hours and the pregnancy is less than 12 weeks along. The measure would also ban gender-affirming surgery or medications for minors.

The legislature approved the measure on the penultimate day of its session after fierce opposition from Democrats and infighting among Republicans, some of whom argued that the new amendment should not include exceptions for rape and incest.

The move bucks the trend on abortion-related ballot measures. Voters have sided with abortion rights in 14 out of 17 times that the question has appeared on state ballots in the three years since the U.S. Supreme Court overturned Roe v. Wade, which had for five decades recognized a right to abortion in the Constitution. Opponents of abortion rights have grown wary of putting the question before voters, and in states such as Florida and Arkansas, are instead trying to make it harder for citizens to put questions on the ballot, or pass ballot measures.

But Republicans who control the levers of state government in Missouri have long been fiercely anti-abortion; it was the first state to officially ban abortion after the court overturned Roe. They are hoping it will not take much to reverse the amendment approved in November, which passed with support from just under 52 percent of the vote.