KANSAS CITY, Mo. — A Missouri judge on Friday cleared the way for abortion procedures to begin in Kansas City and across the state, blocking clinic licensure rules that represented the last remaining obstacles to renewed access.

Jackson County Circuit Court Judge Jerri Zhang halted a requirement that abortion clinics must obtain state licenses – a decision Planned Parenthood had said was needed for its clinics to begin providing abortions. The licenses came with rules that providers called onerous and unethical, including mandatory pelvic exams for women.

The decision marks a key moment in the push by abortion rights supporters to restore access. Missouri voters in November approved Amendment 3, a state constitutional amendment that overturned a ban on ending a pregnancy that had been in effect since the U.S. Supreme Court overturned the federal right to abortion in 2022.

Abortion providers didn’t immediately begin offering services after the November vote because the legal status of much of the state’s restrictions on the procedure, enacted over decades, remained unclear. But Zhang’s order stopping the license rules appears to remove a key barrier.

In a three-page decision released Friday afternoon, Zhang wrote that the court “finds the facility licensing requirement is facially discriminatory because it does not treat services provided in abortion facilities the same as other types of similarly situated health care, including miscarriage care.”

Planned Parenthood has previously said that with the licensure rules blocked, several of its clinics – including a location in Kansas City – were prepared to begin offering medication abortions within days.

The organization did not immediately weigh in on the ruling Friday afternoon.

The decision is certain to be appealed. Missouri Attorney General Andrew Bailey, a Republican, is defending the state’s abortion restrictions, including the license rules, and has cast himself as a staunch opponent of abortion. The Missouri Supreme Court is all but guaranteed to make the final ruling in the case.

What remains unclear is whether a higher court will pause Zhang’s order before Planned Parenthood resumes offering abortion. The state Supreme Court or an appeals court could also pause the judge’s decision after abortions resume, leaving open the possibility of stop-and-start access in the state.

Zhang’s decision represented a reversal of her previous thinking. An appointee of former Republican Gov. Mike Parson, the judge in December blocked state officials from enforcing a series of abortion restrictions, including a requirement that patients wait 72 hours between seeing a doctor and having an abortion and another that required doctors to be physically present when a patient takes medication abortion.

The judge left the clinic license rules in place, however. Planned Parenthood filed court papers asking her to reconsider, leading to Friday’s decision.

At a hearing in late January, lawyers for Planned Parenthood emphasized that the license rules treated abortion care at clinics differently than other health care. Amendment 3 prohibits discrimination against abortion providers and others who offer reproductive health care.

They said that while Missouri’s rules mandate abortion clinics to perform pelvic exams, hospitals that perform abortions or offer miscarriage care don’t have a similar mandate.

“These regulations are not narrowly tailored,” Eleanor Spottswood, an attorney representing Comprehensive Health of Planned Parenthood Great Plains, said in court.

Attorneys for Bailey maintain that hospitals also must provide pelvic exams. Even if they don’t, the different standards wouldn’t be discriminatory, the lawyers say.

But Zhang in her new order wrote that the abortion clinic regulations mandate physicians to perform certain exams and testing that are “unnecessary” when the physicians themselves are authorized to make decisions for individual patients.

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