Missouri is within days of losing its last remaining health center that provides abortions. Unless a court intervenes, it will become the first state in the nation without such a clinic.
Planned Parenthood officials say they are filing a lawsuit in state court Tuesday, asking for a restraining order to prevent its St. Louis clinic from being forced to stop offering the procedure after a state license expires Friday.
Planned Parenthood officials say they've been unable to reach an agreement with officials at the Missouri Department of Health and Senior Services, who want to require several doctors who perform abortions at the health center to submit to questioning as a condition of renewing the license.
"This means that more than 1.1 million women of reproductive age in Missouri will live in a state where they cannot receive the health care they need," Planned Parenthood President, Dr. Leana Wen, said in a statement to NPR. "This is a world we haven't seen in nearly half a century."
Planned Parenthood says state officials have indicated the questioning could lead to criminal proceedings or board review for those physicians, who provide the procedure at Reproductive Health Services of Planned Parenthood of the St. Louis Region.
In her statement, Wen described the state's actions as "harassment" meant to "intimidate" physicians who perform abortions.
Bonyen Lee-Gilmore, director of State Media Campaigns for Planned Parenthood, said the situation in Missouri has been unfolding for years and is the result of what she describes as a "weaponized inspections process."
"This didn't happen overnight. It's been a slow drip of restriction after restriction, and we've been warning for some time that abortion access is on the line," Lee-Gilmore said.
The news comes just days after Missouri's Republican governor, Mike Parson, signed a law criminalizing abortion after eight weeks of pregnancy. In a statement upon signing, Parson said the abortion ban sends "a strong signal to the nation that, in Missouri, we stand for life, protect women's health, and advocate for the unborn."
That law makes Missouri the latest in a growing number of states to ban the procedure in the early stages of pregnancy, often before women even know they're pregnant. Doctors convicted of violating the Missouri law could face prison time. Several states have passed similar early bans in recent weeks, but none have taken effect so far. Legal challenges are underway, and federal judges in Mississippi and Kentucky have already blocked such laws.
But even without banning the procedure, restrictive health regulations can force clinics to stop offering abortions or close altogether. A Planned Parenthood clinic in Columbia, Mo., stopped performing the procedure in October 2018, after it was unable to fulfill a state requirement that doctors performing the procedure have admitting privileges at a hospital within about 15 minutes of the clinic. Planned Parenthood officials say there are some hospitals in Missouri that will perform abortions under rare circumstances, such as a medical emergency.
Missouri is now one of six states with only one remaining clinic, according to data from the Guttmacher Institute, which supports abortion rights.
The St. Louis clinic will continue to provide services such as birth control and health screenings, but will have to stop offering abortions unless a judge grants a restraining order. Patients seeking abortions in Missouri would then have to travel hundreds of miles, to clinics in Kansas or Illinois, Wen said.
Wen said it would be the first time in decades that an entire state would be without a health center offering abortions.
"This is a tragedy for Missouri women and doctors. And it's a disturbing preview of what anti-choice politicians are trying to implement across the country," Wen said.
Planned Parenthood officials say they have reached agreements with state health officials on other rules, including a requirement that physicians perform two pelvic examinations on women seeking surgical abortions.
Dr. Colleen McNicholas, an abortion provider at the St. Louis clinic, said in a statement provided by Planned Parenthood that repeat pelvic exams are "medically unnecessary and invasive."
"For some patients, this can even be re-traumatizing," McNicholas said in the statement. "In this case, we had to weigh this against abortion access for an entire state — a nearly impossible decision and state officials know it."
Planned Parenthood has stopped offering medication abortions in Missouri because of that requirement.
Dr. Sarah Horvath, a fellow at the American College of Obstetricians and Gynecologists who is aware of the negotiations in Missouri, said via email that such policies "harm the patient-physician relationship and erode patient trust."
Asked about the state's move to question abortion providers, Horvath said the procedure is "highly over-regulated due to stigma and politics. ... Doctors should be able to provide health care without fearing interrogation."