A surgical room is prepped for patients on Friday, June 21, 2024, at Planned Parenthood Great Plains in Overland Park, Kansas (Anna Spoerre/The Missouri Independent).
Two of Missouri’s nine Planned Parenthood clinics are poised to start performing regularly-scheduled surgical abortions next week, though clinic leadership says access to medication abortions is in the hands of the state.
The first elective abortion in Missouri since the procedure was banned in 2022 was performed earlier this month in a Kansas City Planned Parenthood clinic. It will now be offering regular appointments for surgical abortions along with the clinic in Columbia, which has not offered the procedure since 2018.
Two weeks ago, Jackson County judge Jerri Zhang struck down the final few regulations for Missouri abortion providers, calling them “unnecessary” and “discriminatory,” opening the door for abortions to resume. The regulations run afoul of the constitutional amendment granting the right to abortion, which voters passed in November as Amendment 3.
Among these now defunct regulations is a requirement that abortion clinics submit a complication plan for medication abortions.
While Zhang blocked the regulations connected to the complication plan, the statute itself remains, said Emily Wales, president and CEO with Planned Parenthood Great Plains.
We’re in uncharted territory here, because we don’t have regulations that tie to the statute, because they’re blocked. I would be somewhat surprised if (the state) came back and said they are fine with the plan.
– Emily Wales, president and CEO with Planned Parenthood Great Plains
Wales said Planned Parenthood submitted a complication plan to the state last week, but there has been no indication as to how long it will take to review the plans. Until that approval arrives, medication abortions cannot begin, Wales said.
The Missouri Department of Health and Senior Services, which is charged with approving the plan, did not provide comments on the approval process.
“We’re in uncharted territory here, because we don’t have regulations that tie to the statute, because they’re blocked,” Wales said. “I would be somewhat surprised if (the state) came back and said they are fine with the plan.”
In 2023, 63% of abortions in the United States took place using medication rather than surgical procedures, according to the Guttmacher Institute, a reproductive rights research group. That number is increasing as the number of states with bans and restrictions on abortions grow.
In states where abortion is legal, medication that induces a miscarriage is available to patients in their first trimester of pregnancy. Patients typically take two doses of medication, the second of which is often taken at home. In recent years, a growing number of women have been ordering abortion medication from online providers in the United States and abroad.
Wales said Planned Parenthood’s clinics in Kansas City and Columbia are stocked with abortion medication and ready to administer it as soon as the state allows. Leadership at the clinic in St. Louis said they are also ready to begin providing the medication as soon as the state green lights it.
“We are hoping that the state acts in good faith,” Wales said. “And recognizes that our process for managing complications is in line with the standard of care nationally.”
Abortions to resume in Columbia, Kansas City
The first elective abortion to take place in Columbia since 2018 is scheduled for Monday.
Nearly seven years ago, the clinic in central Missouri stopped seeing abortion patients after a new law required abortion providers to have admitting privileges at a nearby hospital.
Soon, appointments will be available at least one day a week.
The Kansas City clinic, located 125 miles west on Interstate 70, performed the first elective abortion in nearly three years in Missouri on Feb. 15. No other patients have undergone the procedure since.
But beginning Wednesday, the clinic will begin seeing patients for regularly-scheduled surgical abortions at least one day a week. Initially, they are scheduling patients up until 12 weeks in pregnancy, but Wales said they intend to expand the gestational age as they figure out scheduling.
The clinic also hopes to expand the pain management offered for surgical abortions. Initially, they plan to offer patients Valium and local anesthetic. Down the road Wales said they hope to also offer IV sedation.
The lag between the first abortion patient and the second was due to logistics. But weather and a holiday weekend also played a role.
A snowstorm that week forced the clinic to cancel other appointments and the physicians who came in to perform the first abortion hadn’t been scheduled to work the weekend of President’s Day. Instead, they offered to come in on their day off to take part in the historic moment.
Anti-abortion advocates split over push to renew Missouri ban with rape, incest exceptions
While Columbia and Kansas City will only be offering appointments one day a week for the first couple months, both hope to expand as they adjust providers’ schedules and new staff physicians come on board.
Planned Parenthood Great Plains, which runs clinics in Kansas, Western Missouri and Oklahoma, has five physicians based in the Kansas City area. Wales said they hope to add at least one more staff physician in the coming months. The clinics also rely on a network of about half a dozen out-of-state contracted physicians to coordinate care at the clinics, which primarily includes contraceptives, STI testing, cancer screenings and wellness checks.
The equipment used in surgical abortions has been on a tri-state tour in recent years, Wales said. After the Columbia clinic ended the procedure, the equipment went to Oklahoma, which at the time was seeing a surge in Texans following that state’s 6-week ban. When Oklahoma’s ban went into effect, the equipment was sent to Kansas as more Texans and Oklahomans started traveling north for the procedure.
Now, it’s back in Columbia.
Wales said it’s not immediately clear what the demand for abortion appointments will be in Missouri. In 2023, Kansas saw a 58% increase in abortion appointments as bans took effect in neighboring states. Wales is anticipating the clinics in Columbia and Kansas City could see patients traveling in from Iowa, Arkansas and even Louisiana.
“One of the challenges for us is that we still have an overwhelming need in Kansas, and we’re going to have to take some time to figure out how patients travel,” Wales said. “If the demand is higher in Missouri, we will increase access there.”
No set date to begin abortions again in St. Louis
The Planned Parenthood clinic in St. Louis’ Central West End was the last clinic in Missouri to provide an abortion before Roe v. Wade was overturned.
Clinic leadership, wary of the ongoing court battle, has not yet started scheduling out abortion appointments in St. Louis.
Dr. Margaret Baum, interim chief medical officer for Planned Parenthood Great Rivers, which runs clinics in eastern and southern Missouri and southern Illinois, said it was too soon to provide a timeline of when surgical abortions will return to St. Louis.
“We moved all of our services to Illinois, our nursing staff, our anesthesia equipment, physician presence, all of those things,” she said. “So it’s going to take a little bit of time to bring things back to Missouri.”
The St. Louis location previously offered abortions up to 21 weeks, six days gestation. Baum said she imagines they will offer the procedure up until that point again once services restart.
A 20 minute drive across the river in Fairview Heights, Illinois, patients can be seen up to 28 weeks, six days gestation.
While a lot of uncertainty remains around surgical abortions, Baum said the St. Louis clinic is ready to start providing medication abortions as soon as the state clears them to do so.
But even though medication abortion is easier to provide — it requires fewer staff and less equipment — Baum said the clinics in Springfield and Rolla won’t be able to make the medication available to patients because neither clinic has doctors on staff, citing a state law that requires only physicians perform the procedure.
She said bringing physicians to Springfield and Rolla “is certainly a discussion, but “right now, we have to focus our physician power in our very, very busy service in Illinois, and bringing things back to Missouri.”
Baum is one of two long-term staff physicians and one contracted physician at Planned Parenthood Great Rivers.
When she started at Planned Parenthood in St. Louis several years ago, an ultrasound technician saw patients, then Baum reviewed the ultrasound images before moving on with the procedure. But then Missouri law changed and suddenly she was required to do the ultrasound, cutting into her time with other patients.
Then came the mandatory 72 hour waiting period between seeing a provider and having an abortion. That was followed by a requirement that the same physician who walked the patient through the required informed consent process also be the one to do their abortion 72 hours later.
Across the river in Illinois, there was no waiting period, no physician consent requirement and no pelvic exam required for medication abortions.
While Baum said Planned Parenthood celebrated the judge’s most recent decision, many are also wary of what the state could do next.
This legislative session, dozens of bills have been filed seeking to restrict Amendment 3. This includes multiple proposed constitutional amendments seeking to put an abortion ban on the ballot as soon as this year.
“It is important to remember that while we celebrated this victory last Friday, it is temporary, so we are still a little bit nervous that things could change,” she said. “We don’t know what will happen in January, when the actual court case takes place. So before we put too much effort into reopening services in St. Louis, if things could then change, we still have to focus where we have this facility in Illinois, to keep that running.”
Legal battles continue to complicate planning
On Saturday, Attorney General Andrew Bailey filed a request for a temporary restraining order or preliminary injunction, asking a Cole County judge to temporarily halt the Columbia and Kansas City clinics from performing abortions. The state has been attempting to move Planned Parenthood’s lawsuit against the state from Jackson County to Cole County.
The filing is part of a separate lawsuit filed late last year by the attorney general’s office arguing that Planned Parenthood doesn’t have the grounds to sue because of a 2010 settlement agreement between Planned Parenthood and the state.
“More than anything, I think it’s an attempt to get out of a court where they’re unhappy with the outcomes they’re seeing,” Wales said. “But also to delay, distract and prevent Missourians from access and care.”
Planned Parenthood has requested that the case be transferred to Jackson County. A status hearing in the Cole County case is scheduled for March 12.
Bailey is also expected to appeal the most recent order out of Jackson County which allowed Planned Parenthood to restart surgical abortions.
In an email Tuesday, a spokeswoman for the attorney general said the office intends to appeal the judge’s Feb. 14 order “immediately.” As of Thursday, the office had not filed an appeal.
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