What the end of abortions in Missouri means for neighboring states

This is a Kaiser Health News story

As the last abortion clinic in Missouri warned that it will have to stop providing the procedure as soon as Friday, abortion providers in surrounding states said they are anticipating an uptick of even more Missouri patients.

At Hope Clinic in Granite City, Ill., just 10 minutes from downtown St. Louis, Deputy Director Alison Dreith said Tuesday her clinic was preparing for more patients as news about Missouri spread.

“We’re really scrambling today about the need for increased staff and how fast can we hire and train,” Dreith said.

And at a Trust Women clinic in Wichita, Kan., that already has to fly in doctors, the staff didn’t know what it would mean for their overloaded patient schedule.

“God forbid we see that people can’t get services in Missouri,” said Julie Burkhart, Trust Women founder and CEO. “What is that going to mean on our limited physician days?”

If St. Louis’ Planned Parenthood clinic is unable to offer abortions, the group said, Missouri would be the only state in the country to not have an operating abortion clinic. Five other states — Kentucky, Mississippi, North Dakota, South Dakota and West Virginia — reportedly have only one abortion clinic. And 90% of U.S. counties didn’t have an abortion clinic as of 2014, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

For some, this echoes back to the days before abortion was legalized nationwide in 1973 with the Supreme Court’s Roe v. Wade decision, when patients who could afford to travel would go to more liberal states like California or New York where abortion was legal.

But providers in Kansas and Illinois say this influx from Missouri isn’t new. About half of their clients already come from the Show Me State. To the south, in neighboring Arkansas, where a 72-hour waiting period will go into effect in July, the vast majority of its patients still live within the state.

Over the past 10 years, four Missouri abortion clinics have closed because of increased regulations, including a mandatory 72-hour waiting period after receiving counseling on abortion, thus requiring two trips to a facility; requirements that physicians have hospital admitting privileges within 15 minutes of their clinics; and a rule requiring two-parent notification for minors and one-parent notarized consent. All those limits left one clinic in downtown St. Louis to serve the whole state.

Now Planned Parenthood, which operates that final abortion clinic, said Tuesday it will be forced to end its abortion services altogether by Friday if the state suspends its license. The closure is not related to new anti-abortion laws that Missouri Gov. Mike Parson, a Republican, signed last week to ban most abortions after eight weeks of pregnancy. The new laws don’t take effect until August.

Already the number of patients in Missouri seeking an abortion at the clinic from April 2018 until this April had dropped by 50% compared with the same period the previous year. Planned Parenthood spokesman Jesse Lawder attributes two-thirds of the decrease to the clinic’s refusal to do pelvic exams for abortions performed through medication — recently required by the state — thus forcing all such abortions to be performed out of state.

For Dreith, while she expects the Missouri numbers to continue to grow at her Illinois clinic across the Mississippi River, it’s not the only state sending patients her way.

“Patients were literally coming to us from the last remaining clinics in Kentucky … so that they wouldn’t get past 24 weeks,” Dreith said. “We don’t want these patients in surrounding states traveling [to] New York [or] California like they once had to.”

That’s how it was prior to the Roe v. Wade ruling, according to Mary Ziegler, a professor at the Florida State University College of Law who is writing her third book on the history of the legal battle around abortion access. She anticipates the pattern of privilege will repeat itself.

“You would still expect women with resources to be able to travel as far as they needed,” she said. “And you would expect women without resources to not be able to travel. … The more the court retreats from protecting abortion rights, the more stark those differences will become.”

For Dreith, the historical comparison to the pre-Roe era rings true, albeit with improved medical practices.

There are safer, easier and more effective ways to perform abortions now than the “horror stories that we saw pre-Roe,” said Dreith. “But I think the travel will be one of the huge throwbacks and the scariest part will be the criminalization.”

States such as Missouri could feel pressure to start arresting women who perform their own abortions with pills at home or travel out of state, Ziegler said. But, she said, “punishing women isn’t something that’s thought to be very popular.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.