A Decade Ago Missouri Had 5 Abortion Clinics. Now It Has One. Here's What Happened.

Eleven years ago, Missouri had five abortion clinics. Today, the state has just one — and it may close in a month.

On Friday, Planned Parenthood of St. Louis won a last-minute reprieve that will allow it to keep offering the procedure until August. But the clinic is still facing the prospect of losing its abortion license altogether, which would leave Missouri the first state in decades without an abortion provider.

How did this happen?

The story of the erosion of abortion access in Missouri is the same story that played out in states across the country. After winning majorities in many state legislatures in the 2010 elections, Republicans successfully pushed for restrictions that gnawed away at the protections guaranteed by Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide. This slow-but-steady campaign, they hoped, would one day eliminate abortion completely.

Those measures did help force clinics to close: Between 2013 and 2018, about 275 facilities stopped offering abortions, according to an analysis by the New York Times. Approximately 750 abortion clinics now remain in the United States. Missouri is one of six states with only one clinic.

M’evie Mead, director of Policy and Organizing at Planned Parenthood Advocates Missouri, has watched what she calls a “tremendous politicization of abortion” develop in the decades since she started working as an abortion rights activist.

“As the courts have changed and become less favorable to protecting access to abortion rights Missouri has always tried to get up to and push that line,” Mead said. “And there’s some very dedicated and sophisticated — honestly — advocates who want the government to ban abortion.”

In 1986, Missouri became the first state in the nation to require doctors who perform abortions to be able to admit patients at a hospital “in the community.” Translation: within a 15 minute drive of the clinic.

Then, in 2007, Missouri’s legislature passed a bill that was, ostensibly, about letting schools offer abstinence-only sex ed. But tucked in the very bottom of the bill was a measure requiring establishments that performed more than five first-trimester abortions a month, or intended to perform any second- or third-trimester abortions, to be categorized as a “ambulatory surgical center.”

That reclassification left abortion clinics facing enormous renovation costs. They suddenly needed to have facilities that met specific requirements, like ensuring that all hallways were wider than 60 inches, and doorways wider than 32 inches.

Abortion opponents have long argued that regulations like these help ensure that women are safe. But abortion rights activists, who call such measures amount to the “targeted regulation of abortion providers” (or “TRAP” laws), contend that they’re medically unnecessary and actually just intended to close clinics.

Missouri’s local Planned Parenthood affiliate sued over the 2007 law, and eventually won exemptions for two of its clinics. But, in the meantime, the political climate around abortion had worsened.

Over time, hospitals became less willing to grant abortion providers admitting privileges, endangering clinics, said Mallory Schwartz, executive director of NARAL Pro-Choice Missouri. "It might not be nefarious actions on [the part of] hospitals,” she said. Instead, they could have been driven by “fear, also concern about being caught up in this cycle of court actions that really disrupts the ability of any clinic to provide continuity and clinical care to their parents."

By 2016, these laws had forced all but one Missouri clinic to stop offering abortions.

Still, that year, abortion rights advocates in Missouri thought they saw a chance to revive their state’s clinics. The Supreme Court ruled that similar restrictions in Texas placed an unconstitutionally heavy burden on women seeking abortions, and struck them down. (After the restrictions had already halved the state’s number of abortion clinics.) Missouri activists thought they could use the decision to knock down their state’s restrictions on both ambulatory surgical centers and admitting privileges, and open more abortion clinics.

The Eighth Circuit Court of Appeals put a stop to that plan in 2018. Because clinics were able to secure waivers that allowed them to avoid the restrictions, a three-judge panel decided that they had “less than adequate information” about the restrictions’ impact on women, and put them back into place.

Thanks to the decision, an abortion clinic in Columbia had to stop offering the procedure, and attempts to provide abortion access in Joplin, Springfield, and Kansas City were also put on hold.

In May of this year, Missouri’s health department notified Planned Parenthood of St. Louis, the last clinic in the state, that it had questions about what it called “deficient practices” at the clinic. According to department documents that were later sealed, there were concerns about three purported “failed abortions” where patients remained pregnant and needed additional surgeries. In another case, a patient reportedly developed life-threatening complications.

Missouri wanted the clinic to adjust how it provided state-mandated counseling for abortion patients, to have patients undergo two pelvic exams before the procedure, and to provide physicians for interviews with state officials. Planned Parenthood said it could not provide all of the requested physicians, since some were not employed by the organization, and sued the state.

Then, one day before Missouri had to decide whether to renew the clinic’s license, Planned Parenthood of St. Louis announced it also would not perform more than one pelvic exam on patients. Doing more was, in the words of the clinic’s medical director, “inappropriate, medically unnecessary, unethical.”

Missouri ultimately declined to renew the clinic’s license to perform abortions.

Now, Planned Parenthood must make its case to the Administrative Hearing Commission in an August 1 hearing. Even if it loses, Mead says that the organization plans to continue providing other services at the clinic.

Schwartz, meanwhile, has already pledged to fight back. If the clinic is forced to stop providing abortions, she said, “For Missourians, it’s a rallying cry.”

“This is a moment for this movement to fight back.”

Cover: Ashlyn Myers of the Coalition for Life St. Louis waves to a Planned Parenthood staff member on Friday, June 28, 2019. The Missouri Administrative Hearing Commission issued an order Friday allowing the clinic to continue performing abortions until it takes up its case later this year. (Robert Cohen/St. Louis Post-Dispatch via AP)