MAPLEWOOD, Mo. — Missouri voters will return to a familiar ballot question in November, but the meaning of the vote will be reversed. In 2024, voters approved Amendment 3, adding abortion protections to the state constitution. This year, a “no” vote on another measure carrying the same designation would preserve those protections. A “yes” vote would repeal them and replace them with a ban on abortion, with exceptions for medical emergencies, certain fetal anomalies and pregnancies resulting from rape or incest. The rape and incest exceptions would apply only through 12 weeks of pregnancy. The 2024 amendment protects abortion access through fetal viability, generally understood to be the point when a fetus can survive outside the uterus. The measure is being placed before voters by Missouri’s Republican-dominated Legislature. Missouri is the only state voting this year on whether to remove abortion protections already written into its constitution. The unusual repeat vote has created confusion among voters and campaign workers. Kelly McCoomb, a resident of Maplewood in suburban St. Louis, saved her 2024 yard sign supporting abortion rights and put it back out after covering the word “YES” with black duct tape and adding “NO.” “I have little faith in our Missouri government,” McCoomb said. She said abortion access matters to her because she wants her daughter to grow up in a state where the option remains available if needed. Margot Riphagen-Dunn, chief executive of St. Louis-based Planned Parenthood Great Rivers, said the political uncertainty has echoed the confusion patients have faced about whether abortion services are available in Missouri. “Chaos is kind of the point here,” Riphagen-Dunn said, calling the uncertainty an obstacle to providing care. The measure’s wording has also complicated organizing by abortion opponents. Reagan Barklage, a vice president of Students for Life of America and treasurer of the Missouri Students for Life Ballot Committee, said canvassers have had to explain to anti-abortion voters that they must vote “yes” this year even if they voted “no” on Amendment 3 in 2024. “People need to be very clear on what they’re voting for,” Barklage said. The campaign comes amid a broader national shift in abortion policy following the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned the federal constitutional protections established by Roe v. Wade. Since then, states have adopted sharply different rules, ranging from near-total bans to constitutional protections and laws intended to shield abortion providers from investigations by other states. Missouri was the first state to ban abortion after the Dobbs ruling. Abortion had already become rare there after years of restrictions, including a 72-hour waiting period, building requirements for clinics and a requirement that clinicians have admitting privileges at nearby hospitals. State records show that 150 abortions were performed in Missouri in 2021, down from 5,772 in 2011. Although Missouri voters approved abortion protections in 2024, medication abortions did not resume in the state for nearly two years. A judge later struck down restrictions that had prevented providers from restarting those services. Missouri is one of four states with abortion-related measures on the November ballot. Nevada voters will again consider a constitutional amendment protecting abortion access after 64% supported it in 2024; the state requires constitutional amendments to pass in two elections. Idaho voters will decide whether to allow abortion through fetal viability, while Virginia voters will consider adding existing abortion rights to the state constitution. For Missouri voters, the immediate question is whether to retain the protections adopted two years ago or replace them with a new ban. McCoomb said she hopes her altered sign helps people remember to read the measure carefully before voting. “I hope lots of people see and remember to revote,” she said.